In Lisbon, 3% of TB cases are extremely drug-resistant
Derek Thaczuk, Thursday, August 21, 2008
Portuguese Researchers reported over the past week, at the XVII International AIDS Conference in Mexico City, which 3% of cases of tuberculosis (TB) diagnosed between 2003 and 2007, one of the largest hospitals in Lisbon, were extremely resistant to drugs, there a strong correlation between infection by HIV or hepatitis C and this form of tuberculosis.
The drug-resistant tuberculosis (TB XDR), which was first described in 2006 is defined as being resistant to at least the two first-line drugs - rifampin and isoniazid - as well as either injectable second-line used to treat TB (amikacin, kanamycin or Capreomycin) and fluoroquinolone.
XDR-TB has emerged on a large scale in South Africa, often as a result of transmission through the local health care where they join a large number of HIV positive patients and vulnerable.
A poster presented at the International AIDS Conference described the cases observed d XDR-TB in the infectious diseases ward of the Curry Cabral Hospital in Lisbon, Portugal, and between 2003 2007. For this retrospective study, we analyzed all positive cultures from TB and was collected during that period of time, Having been conducted additional testing of drug resistance, validated reference laboratories.
The study included patients with confirmed TB 595 culture during the years 5, 68 (11,4%) of which were multidrug-resistant TB (MDR-TB) and 17 (2,9%) had XDR-TB. 17 of cases of XDR-TB, 82% were men, with an average of 41.7 years 65% were Caucasian and 35% were black. The mean duration of hospitalization was 61 days. 65% were HIV-positive, with an average score of the CD4 116 cells / mm3. Forty percent of cases of XDR-TB were treated with antiretroviral therapy, 52% had hepatitis C. It was found that there is a history of TB in 64% of cases and 63% there was a previous diagnosis of MDR-TB.
The Mycobacterium tuberculosis was isolated from sputum in 88% of patients in 6% in gastric juice and 6% in bronchoalveolar lavage. All patients had pulmonary manifestations (with caves 76%) and two had extra-pulmonary manifestations (ganglion). The average time to achieving persistent negative cultures was 49,4 days.
For resistance to first-line drugs, 82% were resistant to all 4 drugs (isoniazid, rifampicin, ethambutol, pyrazinamide), 12% of these three drugs and two 6%. Over the were resistant to all second-line injectable drugs and fluoroquinolones. There were two deaths. Encouragingly, of the patients (53%) samples was discharged after persistent negative cultures.
The researchers concluded that "XDR-TB was, in our study, an infection associated not only with HIV but also with HCV, intravenous drug abuse and also with the worst socio-economic conditions." (The detailed analyzes of socio-economic factors of IDUs were not available) also stated that although deaths due to XDR-TB "were not very high ... our data reinforce the need for better surveillance and effective treatment to all patients."
Maltez F et al. Extensively drug-resistant tuberculosis – case analysis 2003/2007. Seventeenth International AIDS Conference, Mexico City, abstract MOPDB207, 2008.
GAT - Portuguese Activist Group on HIV / AIDS Treatments