Characterization of resistance profile of Mycobacterium tuberculosis isolates from patients with tuberculosis in Beira, Sofala - Mozambique

Evangelina Inácio Namburete,Miguelhete Lisboa,Inês Tivane,Valdes Roberto Bollela,Lee Harrison

doi:10.11606/issn.2176-7262.v49i4p338-343

Abstract

Objective: To analyze the resistance profile of Mycobacterium tuberculosis isolates from patients with tuberculosis in Beira, Sofala, Mozambique. Method: Descriptive cross-sectional study that analyzed secondary data from patients who had positive culture for M. tuberculosis on MGIT960-BACTECTM. For each patient, demographic data, information of Human Immunodeficiency Virus (HIV) serology, rapid molecular test - GeneXpertα-Cepheid result and first line drug susceptibility test (DST) were reviewed . All tests were performed in the Referral Laboratory of Tuberculosis in Beira, from January 2014 to March 2015. Findings: Totally of 87 isolates from Sofala province, Mozambique were analyzed. Of these, 33/87 (37.9%) isolates had any anti-TB drug resistance detected while in 54/87 (62.1%) the drug resistance was not detected. Among the 33 isolates with drug resistance: 18/33 (54,7%) were multidrug-resistant (MDR), 11/33 (33,3%) were Isoniazid (INH) mono-resistant, 2/33 (6%) Rifampicin (RIF) mono-resistant and 2/33 (6%) were Etambutol mono-resistant. Of the total isolates with resistance to INH, 5/11 (42%) were additionally resistance to streptomycin (Sm). Of the 49 patients with HIV serology known, 30 (61,2%) were confirmed HIV positive. The HIV infection was two times more frequent among patients with drug resistant compared to those without drug resistance. All isolates resistant to INH and RIF (MDR) had previous history of tuberculosis treatment. Conclusion: There is high proportion of co-infection TB/HIV among patients with any drug resistant TB MDR or monoresistance . We also observed high frequency of monoresistance to isoniazid and association of drug resistance between isoniazid and streptomycin

Highlights

Somente os isolados que apresentaram resistência à rifampicina e as amostras de pacientes que tinham historia de tratamento prévio de TB foram submetidos a teste de sensibilidade aos fármacos de primeira linha (Streptomycin Isoniazid Rifampicin Etambutol– BACTECTM)
Embora alguns estudos que foram feitos em outros países da África Subsahariana mostraram uma frequência menor de TB multidrogarresistente (TB-MDR) em pacientes previamente tradados 27,2% e 10.3 %.[12]
Em todos os isolados que tiveram a resistência a RIF e INH detectada pelo teste fenotípico, os respectivos pacientes tinham historia prévia de tratamento para TB, ou seja, eram casos de resistência adquirida ou secundária

Summary

Introduction

Por conta da alta frequencia da co-infecção entre o HIV e TB, em 2013, Moçambique aderiu à recomendação da Organização Mundial de Saúde (OMS) para o tratamento em massa da TB latente com isoniazida (INH) em todo indivíduo que estivesse infectado pelo HIV, independentemente do resultado do teste tuberculínico e do grau de imunodepressão do paciente, após excluir doença ativa.[7] Somente os isolados que apresentaram resistência à rifampicina e as amostras de pacientes que tinham historia de tratamento prévio de TB foram submetidos a teste de sensibilidade aos fármacos de primeira linha (Streptomycin Isoniazid Rifampicin Etambutol– BACTECTM).

Results

Conclusion