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Revista Portuguesa de Pneumologia

versão impressa ISSN 0873-2159

Rev Port Pneumol v.13 n.6 Lisboa dez. 2007

 

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 Costeira 1

Jaime Pina 2

 

 

Resumo

A tuberculose multirresistente é uma ameaça importante ao controlo da tuberculose.

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 Mycobacterium tuberculosis complex.

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% versus 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% versus 15%, respectivamente.

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%).

A demora média para obter os resultados foi de 7,6 dias para o teste genotípico versus 23,4 dias para o teste fenotípico (BACTEC MGIT 960).

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.

Palavras-chave: Tuberculose multirresistente, método genotípico, sensibilidade, especificidade.

 

 

 

Abstract

The multi-drug resistant Tuberculosis (MDRTB) is a huge menace to Tuberculosis control.

The early detection of MDRTB is essential to best appropriate measures.

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 Mycobacterium tuberculosis complex.

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.

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.

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%).

Time to obtain the results was 7.6 days for the genotypic test versus 23.4 days to the phenotypic test (BACTEC MGIT 960).

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.

Key-words: Multi-drug resistant tuberculosis, genotypic method, sensitivity, specificity.

 

 

Texto completo disponível apenas em PDF.

Full text only available in PDF format.

 

 

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1 Assistente Hospitalar Graduado de Pneumologia

João.Costeira@hpv.min-saude.pt

2 Chefe de Serviço Hospitalar de Pneumologia e Director do Serviço de Pneumologia 2 do Hospital de Pulido Valente, Lisboa

Hospital de Pulido Valente, EPE

Alameda das Linhas de Torres

117 1769-001 Lisboa

 

Recebido para publicação/received for publication: 07.07.02

Aceite para publicação/accepted for publication: 07.09.12