Drug resistance of M. Tuberculosis isolated from patients with HIV infection seen at an AIDS Reference Center in São Paulo, Brazil

Pinto, Walkyria P; Hadad, David J; Palhares, M. Cecília A; Ferrazoli, Lucilaine; Telles, M. Alice S.; Ueki, Sueli Y.M.; Santos, Márcia T. F.; Placco, Ana L. N.; Sauaia, Naim; Palac, Moisés

doi:10.1590/S0036-46651996000100004

Abstracts

M. tuberculosis-positive cultures were obtained from 228 patients seen in our service and drug sensitivity assays were carried out from January 1992 to December 1994. A survey of the medical records of these patients showed resistance to one or more drugs in 47 (20.6%), 25 of whom (10.9%), who reported previous treatment, were considered to have acquired resistance. Among the antecedents investigated, only previous treatment and alcoholism were the factors independently associated with the occurrence of resistance. The survival of patients with resistant strains was lower than that of patients attacked by non-resistant M. tuberculosis. We conclude that in the present series M. tuberculosis resistance to tuberculostatic agents was predominantly of the acquired type.

Tuberculosis; Tuberculosis treatment; AIDS; Multidrug resistance; Drug resistance; HIV infection

No período de janeiro de 1992 a dezembro de 1994, foram obtidas culturas positivas para M. tuberculosis e foram realizados testes de sensibilidade a drogas em 228 pacientes atendidos no Centro de Referência DST/AIDS-SP. Através da revisão dos prontuários de todos os casos verificamos resistência a uma ou mais drogas em 47(20.6%), dos quais 25(10.9 %), que relatavam tratamento pregresso, foram considerados como portadores de resistência adquirida. Dos antecedentes investigados, somente os fatores tratamento prévio e alcoolismo foram independentemente associados à ocorrência de resistência. A sobrevivência dos pacientes portadores de cepas resistentes foi menor que a dos pacientes acometidos por M. tuberculosis não resistentes. Concluimos que nesta casuística a resistência do M. tuberculosis aos tuberculostáticos foi predominantemente do tipo adquirida.

MICROBIOLOGY

Drug resistance of M. Tuberculosis isolated from patients with HIV infection seen at an AIDS Reference Center in São Paulo, Brazil

Resistência a drogas de M. tuberculosis isolados de pacientes com infecção pelo HIV atendidos no Centro de Referência e Treinamento DST/AIDS, São Paulo, Brasil

Walkyria P. Pinto^I,III; David J. Hadad^I; M. Cecília A. Palhares^I; Lucilaine Ferrazoli^II; M. Alice S.Telles^II; Sueli Y.M. Ueki^II; Márcia T. F. Santos^I; Ana L. N. Placco^I; Naim Sauaia^III; Moisés Palaci^II

^ISTD/AIDS Reference and Training Center, Health Department of the State of São Paulo. São Paulo, SP, Brazil

^IIAdolfo Lutz Institute, Health Department of the State of São Paulo. São Paulo, SP, Brazil

^IIIFaculty of Medicine, University of São Paulo. São Paulo, SP, Brazil

^{Correspondence to} Correspondence to: Drª Walkyria Pereira Pinto STD/AIDS Reference and Training Center R. Antonio Carlos, 122 - 7. and. 01309-010 São Paulo, SP, Brazil FAX 55 11 287-0147

SUMMARY

M. tuberculosis-positive cultures were obtained from 228 patients seen in our service and drug sensitivity assays were carried out from January 1992 to December 1994. A survey of the medical records of these patients showed resistance to one or more drugs in 47 (20.6%), 25 of whom (10.9%), who reported previous treatment, were considered to have acquired resistance. Among the antecedents investigated, only previous treatment and alcoholism were the factors independently associated with the occurrence of resistance. The survival of patients with resistant strains was lower than that of patients attacked by non-resistant M. tuberculosis. We conclude that in the present series M. tuberculosis resistance to tuberculostatic agents was predominantly of the acquired type.

Keywords: Tuberculosis; Tuberculosis treatment; AIDS; Multidrug resistance; Drug resistance; HIV infection.

RESUMO

No período de janeiro de 1992 a dezembro de 1994, foram obtidas culturas positivas para M. tuberculosis e foram realizados testes de sensibilidade a drogas em 228 pacientes atendidos no Centro de Referência DST/AIDS-SP. Através da revisão dos prontuários de todos os casos verificamos resistência a uma ou mais drogas em 47(20.6%), dos quais 25(10.9 %), que relatavam tratamento pregresso, foram considerados como portadores de resistência adquirida. Dos antecedentes investigados, somente os fatores tratamento prévio e alcoolismo foram independentemente associados à ocorrência de resistência. A sobrevivência dos pacientes portadores de cepas resistentes foi menor que a dos pacientes acometidos por M. tuberculosis não resistentes. Concluimos que nesta casuística a resistência do M. tuberculosis aos tuberculostáticos foi predominantemente do tipo adquirida.

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ACKNOWLEDGMENT

We are indebted to Ivaldo Olímpio da Silva, System Analyst, Department of Preventive Medicine, Faculdade de Medicina, Universidade de São Paulo and to Coordenação de Pneumologia Sanitária do Ministério da Saúde, Brasil

Recebido para publicação em 07/12/1995.

Aceito para publicação em 05/03/1996.

1. BARNES, P.F.; BLOCH, A.B.; DAVIDSON, P.T. & SNIDER, D.E. - Tuberculosis in patients with human immunodeficiency virus infection. New Engl. J. Med., 324: 1644-1650, 1991.
2. BLOCH, A.B.; CAUTHEN, G.M.; ONORATO, I.M.; et al. - Nationwide survey of drug-resistant tuberculosis in the United States. J. Amer. med. Ass., 71: 665-671, 1994.
3. BOLETIM EPIDEMIOLÓGICO AIDS, 8(2), 1995.
4. DAVID, H.L.; LEVY-FREBAULT, V. & THOREL, M.F. - Methodes de laboratorie pour mycobabacteriologie clinique. Unite de la tuberculose et des mycobacteries. Paris, Institut Pasteur, 1986.
5. DAVIDSON, P.T. & LE, H.Q. - Drug treatment of tuberculosis - 1992. Drugs, 43: 651-673, 1991.
6. FRIEDEN, T.R.; STERLING, T.; PABLOS-MENDEZ, A. et al. -The emergence of drug-resistant tuberculosis in New York city. New Engl. J. Med., 328: 521-526, 1993.
7. HAAS, D.W. & DES PREZ, R.M. - Mycobacterium tuberculosis. In: MANDELL, G.L.; BENNETT, J.E. & DOHN, R., ed. Mandell, Douglas and Bennetts principles and practices of infectious diseases. 4.ed. New York , Churchill Livingstone, 1995. p.2213-2224.
8. HOUSTON, S. & FANNING, A. - Current and potencial treatment of tuberculosis. Drugs, 48: 689-708, 1994.
9. KALICHMAN, A.O. - AIDS and intravenous drug use (IVDU) in Brasil. In: MONTEIRO, M.G. & INCIARDI, J.A., ed. Brasil-United States Binational Meeting on Drug Abuse Research, Săo Paulo, 1992. Proceedings. Săo Paulo, 1992. p.49-60.
10. KENT, P.T. & KUBICA, G.P. - Public health mycobacteriology: a guide for the level III laboratory. Atlanta, U. S. Department of Health and Human Services, 1985. (P. B. 86-216546).
11. LIMA FILHO, M.T.; OLIVEIRA, A.G.; NISHI, A.; SARAIVA, L.G.P. & FIUZA DE MELO, F.A. - Resistęncia primária do "Mycobacterium tuberculosis" no Brasil. Rev. Ass. méd. bras., 26: 182-184, 1980.
12. MACHADO, E.S.; CRUZ, M.L.; SOUZA, M.J. et al. - Drug resistant tuberculosis in HIV+ and HIV-patients. In: INTERNATIONAL CONFERENCE on AIDS, 10., Yokohama, 1994. Abstract. p. 168.
13. PINTO, W.P.; CAVALLARI,, M.M.; GEJER, M. et al. - Manisfetaçőes clínicas da AIDS em 163 pacientes ambulatoriais. Rev. Soc. bras. Med. trop, 24 (supl. 2): 54, 1991.
14. PINTO, W.P.; PALACI, M.; SOUZA, R.A. et al. - Drug resistant tuberculosis at an AIDS care unit - Săo Paulo, Brazil. In: INTERNATIONAL CONFERENCE ON AIDS, 10., Yokohama, 1994. Abstract. p. 168.
15. ROSEMBERG, J.; WAISBICH, E. & PASSOS FILHO, M.C.R. - Resistęncia ŕs drogas standard em 1759 casos de tuberculose pulmonar bacilíferos submetidos a quimioterapia por tempos diversos. Rev. Serv. nac. Tuberc., 11: 440-466, 1967.
16. SALOMON, N.; PERLMAN, D.C.; DePALO, V.A.; KOLOKATHIS, A. & WILETS, I. - Drug resistant tuberculosis: factors associated with rise in resistance in an HIV-infected urban population. Mt. Sinai J. Med., 61: 341-348, 1994.
17. SILVA, E.A.M.; SATO, D.N.; TELLES, M.A.S. et al. - Perfil de resistęncia de Mycobacterium tuberculosis no Estado de Săo Paulo, 1986 a 1990. Rev. Inst. Adolfo Lutz, 52: 37-49, 1992.
18. TSUKAMURA, M. - Screening for atypical mycobacteria. Tubercle, 51: 280-284, 1970.
19. VITTI, W. & KRITSKI, A.L. - Retrospective study of short-course anti-TB therapy in HIV infected IVDUs, Santos, Brazil. In: INTERNATIONAL CONFERENCE ON AIDS, 8., Amsterdam, 1992. Abstract. p. 145.
20. WERNECK-BARROSO, E.; VIEIRA, M.A.M.; ALMEIDA, L.H. et al. - Tuberculosis and drug resistance in HIV infected patients in Brazil. A prospective study. In: INTERNATIONAL CONFERENCE on AIDS, 9., Berlin, 1993. Abstract. p.327.
21. WOLINSKY, E. - Statement of the Tuberculosis Committee of the Infectious Diseases Society of America. Clin. infect. Dis., 16: 627-628, 1993.

Correspondence to:

Drª Walkyria Pereira Pinto

STD/AIDS Reference and Training Center

R. Antonio Carlos, 122 - 7. and.

01309-010 São Paulo, SP, Brazil

FAX 55 11 287-0147

Publication Dates

Publication in this collection
22 Sept 2006
Date of issue
Feb 1996

History

Accepted
05 Mar 1996
Received
07 Dec 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BARNES, P.F.; BLOCH, A.B.; DAVIDSON, P.T. & SNIDER, D.E. - Tuberculosis in patients with human immunodeficiency virus infection. New Engl. J. Med., 324: 1644-1650, 1991.

[2] 2. BLOCH, A.B.; CAUTHEN, G.M.; ONORATO, I.M.; et al. - Nationwide survey of drug-resistant tuberculosis in the United States. J. Amer. med. Ass., 71: 665-671, 1994.

[3] 3. BOLETIM EPIDEMIOLÓGICO AIDS, 8(2), 1995.

[4] 4. DAVID, H.L.; LEVY-FREBAULT, V. & THOREL, M.F. - Methodes de laboratorie pour mycobabacteriologie clinique. Unite de la tuberculose et des mycobacteries. Paris, Institut Pasteur, 1986.

[5] 5. DAVIDSON, P.T. & LE, H.Q. - Drug treatment of tuberculosis - 1992. Drugs, 43: 651-673, 1991.

[6] 6. FRIEDEN, T.R.; STERLING, T.; PABLOS-MENDEZ, A. et al. -The emergence of drug-resistant tuberculosis in New York city. New Engl. J. Med., 328: 521-526, 1993.

[7] 7. HAAS, D.W. & DES PREZ, R.M. - Mycobacterium tuberculosis. In: MANDELL, G.L.; BENNETT, J.E. & DOHN, R., ed. Mandell, Douglas and Bennetts principles and practices of infectious diseases. 4.ed. New York , Churchill Livingstone, 1995. p.2213-2224.

[8] 8. HOUSTON, S. & FANNING, A. - Current and potencial treatment of tuberculosis. Drugs, 48: 689-708, 1994.

[9] 9. KALICHMAN, A.O. - AIDS and intravenous drug use (IVDU) in Brasil. In: MONTEIRO, M.G. & INCIARDI, J.A., ed. Brasil-United States Binational Meeting on Drug Abuse Research, Săo Paulo, 1992. Proceedings. Săo Paulo, 1992. p.49-60.

[10] 10. KENT, P.T. & KUBICA, G.P. - Public health mycobacteriology: a guide for the level III laboratory. Atlanta, U. S. Department of Health and Human Services, 1985. (P. B. 86-216546).

[11] 11. LIMA FILHO, M.T.; OLIVEIRA, A.G.; NISHI, A.; SARAIVA, L.G.P. & FIUZA DE MELO, F.A. - Resistęncia primária do "Mycobacterium tuberculosis" no Brasil. Rev. Ass. méd. bras., 26: 182-184, 1980.

[12] 12. MACHADO, E.S.; CRUZ, M.L.; SOUZA, M.J. et al. - Drug resistant tuberculosis in HIV+ and HIV-patients. In: INTERNATIONAL CONFERENCE on AIDS, 10., Yokohama, 1994. Abstract. p. 168.

[13] 13. PINTO, W.P.; CAVALLARI,, M.M.; GEJER, M. et al. - Manisfetaçőes clínicas da AIDS em 163 pacientes ambulatoriais. Rev. Soc. bras. Med. trop, 24 (supl. 2): 54, 1991.

[14] 14. PINTO, W.P.; PALACI, M.; SOUZA, R.A. et al. - Drug resistant tuberculosis at an AIDS care unit - Săo Paulo, Brazil. In: INTERNATIONAL CONFERENCE ON AIDS, 10., Yokohama, 1994. Abstract. p. 168.

[15] 15. ROSEMBERG, J.; WAISBICH, E. & PASSOS FILHO, M.C.R. - Resistęncia ŕs drogas standard em 1759 casos de tuberculose pulmonar bacilíferos submetidos a quimioterapia por tempos diversos. Rev. Serv. nac. Tuberc., 11: 440-466, 1967.

[16] 16. SALOMON, N.; PERLMAN, D.C.; DePALO, V.A.; KOLOKATHIS, A. & WILETS, I. - Drug resistant tuberculosis: factors associated with rise in resistance in an HIV-infected urban population. Mt. Sinai J. Med., 61: 341-348, 1994.

[17] 17. SILVA, E.A.M.; SATO, D.N.; TELLES, M.A.S. et al. - Perfil de resistęncia de Mycobacterium tuberculosis no Estado de Săo Paulo, 1986 a 1990. Rev. Inst. Adolfo Lutz, 52: 37-49, 1992.

[18] 18. TSUKAMURA, M. - Screening for atypical mycobacteria. Tubercle, 51: 280-284, 1970.

[19] 19. VITTI, W. & KRITSKI, A.L. - Retrospective study of short-course anti-TB therapy in HIV infected IVDUs, Santos, Brazil. In: INTERNATIONAL CONFERENCE ON AIDS, 8., Amsterdam, 1992. Abstract. p. 145.

[20] 20. WERNECK-BARROSO, E.; VIEIRA, M.A.M.; ALMEIDA, L.H. et al. - Tuberculosis and drug resistance in HIV infected patients in Brazil. A prospective study. In: INTERNATIONAL CONFERENCE on AIDS, 9., Berlin, 1993. Abstract. p.327.

[21] 21. WOLINSKY, E. - Statement of the Tuberculosis Committee of the Infectious Diseases Society of America. Clin. infect. Dis., 16: 627-628, 1993.

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