Abstract
PurposeTo evaluate the clinical features and treatment outcomes of patients with pulmonary tuberculosis, stratified by level of drug resistance.MethodsThis was a historical cohort study based on data from the II National Anti-Tuberculosis Drug Resistance Survey (2006–2007) collected at eight participating health care facilities in Porto Alegre, southern Brazil. The cohort was followed for 3 years after the start of treatment.ResultsOf 299 cases of smear-positive pulmonary tuberculosis included in the study, 216 (72.2%) were diagnosed at five public primary health care units and 83 (27.8%) at three public hospitals. Among these cases, the prevalence of drug-resistant tuberculosis was 14.4%, and that of multidrug-resistant tuberculosis was 4.7%. Overall, 32.0% of drug-resistant and 2.0% of multidrug-resistant cases occurred in previously treated patients. The most common comorbidity in the sample was HIV infection (26.2%). There was no association between drug-resistant or multidrug-resistant tuberculosis and sociodemographic variables. Cure was achieved in 66.7% of patients, and the default rate was 21.2%. The 2-month sputum conversion rate was 34.2%, and the relapse rate was 16.9%. Patients with drug-resistant tuberculosis had lower rates of cure (45.2%) and 2-month sputum conversion (25%), as well as a higher relapse rate (30.7%).ConclusionThese results highlight the urgent need for a more effective TB control program in this geographical setting, with a major emphasis on treatment of drug-resistant and multidrug-resistant tuberculosis.
Highlights
Tuberculosis (TB) has been considered a worldwide public health problem by the World Health Organization (WHO) since 1993, and global actions have been taken to control this disease [1,2]
Of 299 cases of smear-positive pulmonary tuberculosis included in the study, 216 (72.2%) were diagnosed at five public primary health care units and 83 (27.8%) at three public hospitals
There was no association between drugresistant or multidrug-resistant tuberculosis and sociodemographic variables
Summary
Tuberculosis (TB) has been considered a worldwide public health problem by the World Health Organization (WHO) since 1993, and global actions have been taken to control this disease [1,2]. Preliminary data obtained from the II National Anti-Tuberculosis Drug Resistance Survey conducted between 2006 and 2007, involving 4,421 patients from seven states (Rio de Janeiro, Rio Grande do Sul, Bahia, Distrito Federal, Santa Catarina, Minas Gerais, and São Paulo), show rates of 1.4% (1.0–1.8) for primary MDR-TB and 7.5% (5.7–9.9) for acquired MDR-TB. In Porto Alegre, a large city and the capital of the Southern Brazilian state of Rio Grande do Sul, primary and acquired MDR-TB rates were higher than the national average at 2.2% and 12.0% respectively [7]. This rate for primary MDR-TB is above the upper limit of 2% established by WHO [1]. High rates of TB and HIV co-infection (35.0%) and treatment default (19.6%) have been reported in this geographical setting [8]
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