巴西儿童和青少年耐药结核病的治疗

Fernanda Bruzadelli Paulino da Costa , Thaís Zamboni Berra , Jaqueline Garcia de Almeida Ballestero , Patricia Bartholomay Oliveira , Daniele Maria Pelissari , Yan Mathias Alves , Antônio Carlos Vieira Ramos , Juliana Queiroz Rocha de Paiva , Titilade Kehinde Ayandeyi Teibo , Ricardo Alexandre Arcêncio
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引用次数: 0

摘要

引言耐药结核病(DR-TB)是一个全球性的威胁,也是世界各地公共卫生当局面临的挑战。在儿童中,诊断更具挑战性,文献中对DR-TB及其治疗结果的描述很少。在这项研究中,我们旨在描述巴西儿童和青少年耐药结核病的治疗。方法2013年至2020年巴西15岁以下儿童DR-TB治疗的描述性流行病学研究。主要数据来源是结核病特殊治疗信息系统。使用相对频率(%)和连续变量分析分类变量,通过测量中心趋势来表征病例的特征,即:社会人口统计学、临床特征、程序、测试和治疗成功率。为了核实病例的分布情况,根据病例居住的市镇进行了空间分析。结果2013年至2020年间,19757例结核病病例发生在<;巴西15年,同期报告了46例DR-TB治疗病例(年均6例)。其中,73.9%的患者年龄在10-14岁之间,65.2%的患者为男性,4.3%的患者为艾滋病毒携带者,43.3%的患者在治疗开始时体重不足(BMI<18.5)。17.4%以前接触过结核病,69.6%有原发耐药性,47.8%有多药耐药性。治疗的中位持续时间为15个月。52.2%的病例采用DOT和标准化治疗方案。细菌镜检查阳性率为97.8%(57.8%);培养89.1%(75.6%阳性),快速分子检测73.9%,对利福平的耐药性为55.8%。药敏试验显示主要对异烟肼(87.8%)和利福平(60.6%)有耐药性。73.9%的病例成功治疗,1例死亡。在巴西26个城市治疗了病例,其中里约热内卢(15个)和圣保罗(4个)占多数;1%的一般结核病病例发生在儿童和青少年中,这表明该国对耐药病例的报告不足。尽管登记病例数量较低,但数据反映了该人群中DR-TB的情况,并描述了问题的重要方面,因为儿童需要在不同专业人员的支持下进行全面、个性化的护理。我们建议加强该国的转诊服务,以照顾患有DR-TB的儿童,以便监测和医疗保健服务能够共同识别和跟进病例。
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Treatment of drug-resistant tuberculosis in children and young adolescents in Brazil

Introduction

Drug-resistant tuberculosis (DR-TB) is a global threat and a challenge for public health authorities worldwide. In children, the diagnosis is even more challenging and DR-TB is poorly described in the literature, as are its treatment outcomes. In this study, we aimed to describe the treatment of drug-resistant TB in children and young adolescents in Brazil.

Methods

A descriptive epidemiological study of treatment for DR-TB in children under 15 years of age in Brazil between 2013 and 2020. The primary data source was the Information System for Special Tuberculosis Treatments (SITE-TB). Categorical variables were analyzed using relative frequencies (%) and continuous variables by measures of central tendency to characterize the profile of the cases, namely: sociodemographic, clinical characteristics, procedures, tests performed and treatment success. In order to verify the distribution of cases, a spatial analysis was carried out based on the municipality where the cases resided.

Results

Between 2013 and 2020, 19,757 tuberculosis (TB) cases occurred in children aged <15 years in Brazil, and 46 cases of treatment for DR-TB were reported during the same period (annual average of 6 cases). Of these, 73.9% were aged 10–14, 65.2% were male, 4.3% were HIV+ and 43.3% were underweight (BMI<18.5) at the start of treatment. 17.4% had previous contact with TB, 69.6% had primary resistance, 47.8% multidrug resistance. The median duration of treatment was 15 months. DOT and standardized treatment regimen were performed in 52.2% of cases. Bacilloscopy was performed for 97.8% (57.8% positive); culture for 89.1% (75.6% positive), rapid molecular test for 73.9% with proven resistance to rifampicin in 55.8%. Susceptibility testing revealed resistance mainly to isoniazid (87.8%) and rifampicin (60.6%). 73.9% of cases were successfully treated and one death was reported. Cases were treated in 26 Brazilian municipalities, with the majority in Rio de Janeiro (15) and São Paulo (4).

Conclusion

DR-TB treatment was recorded in <1% of general TB cases in children and young adolescents, suggesting underreporting of drug-resistant cases in the country. Despite the low number of registered cases, the data reflect the situation of DR-TB in this population and describe important aspects of the problem, as the child needs comprehensive, individualized care, with support from different professionals. We recommend a strengthening of the country's referral services for the care of children with DR-TB so that surveillance and health care services can work together to identify and follow up cases.

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来源期刊
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Medicine-Pulmonary and Respiratory Medicine
CiteScore
4.00
自引率
5.00%
发文量
44
审稿时长
30 weeks
期刊介绍: Journal of Clinical Tuberculosis and Mycobacterial Diseases aims to provide a forum for clinically relevant articles on all aspects of tuberculosis and other mycobacterial infections, including (but not limited to) epidemiology, clinical investigation, transmission, diagnosis, treatment, drug-resistance and public policy, and encourages the submission of clinical studies, thematic reviews and case reports. Journal of Clinical Tuberculosis and Mycobacterial Diseases is an Open Access publication.
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