Fatores de risco para a recidiva da tuberculose

Jornal Brasileiro de Pneumologia (Impact Factor: 1.27). 01/2007; 33(5). DOI: 10.1590/S1806-37132007000500013

ABSTRACT Objective: To identify risk factors for recurrence of tuberculosis. Methods: We studied a cohort of 610 patients with active pulmonary tuberculosis who were enrolled for treatment between 1989 and 1994 and cured using a three-drug treatment regimen of rifampin, isoniazid and pyrazinamide (RHZ). The risk factors studied were age, gender, race, duration of symptoms, lesion cavitation, extent of disease, diabetes mellitus, alcoholism, HIV infection, delayed negative sputum conversion, treatment compliance, and medication doses. In order to detect recurrence, the patients were monitored through the Rio Grande do Sul State Healt Department Information System for 7.7 ± 2.0 years after cure. Data were analyzed using the Student's t-test, the chi-square test or Fisher's exact test, and Cox regression models. Results: There were 26 cases of recurrence (4.3%), which corresponds to 0.55/100 patients-year. The recurrence rate was 5.95 and 0.48/100 patients-year in HIV-positive and HIV-negative patients, respectively (p < 0.0001). In the multivariate analysis, HIV infection (RR = 8.04 (95% CI: 2.35- 27.50); p = 0.001) and noncompliance (RR = 6.43 (95% CI: 2.02-20.44); p = 0.002) proved to be independently associated with recurrence of tuberculosis. Conclusions: Recurrence of tuberculosis was more common in HIV-positive patients and in patients who did not comply with the self-administered treatment (RHZ regimen). Patients presenting at least one of these risk factors can benefit from the implementation of a post-treatment surveillance system for early detection of recurrence. An alternative to prevent noncompliance with tuberculosis treatment would be the use of supervised treatment.

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    Jornal Brasileiro de Pneumologia 01/2007; 33(5). DOI:10.1590/S1806-37132007000500001 · 1.27 Impact Factor
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    ABSTRACT: Introduction Tuberculosis (TB) is a greatest public health problem of the world. This work aims to study the antituberculous treatment and the evolution of the patients with recurrent tuberculosis. Patients and method The study is a retrospective study on 64 patients with recidivant pulmonary TB: A1 group: at the first TB attack; A2 group: at the time of recidivant TB, and 105 controls patients with confirmed TB without recidive. Results Multidrug-resistant TB is more frequent with recidivant TB (21.1% vs 3%, P < 0.05) and also extensively drug-resistant. Antituberculous treatment duration in group A1, A2 and T was respectively 8.63 months, 9.79 months, and 7.08 months. Antituberculous drug complications were more frequent in group A2 compared to group T (76.1% vs 41.2%; P < 0.001). Conclusion All tuberculous patients, specially recidivant TB, should benefit of particular care and drug protocol adaptation.
    Revue de Pneumologie Clinique 08/2012; 68(4):233–241. DOI:10.1016/j.pneumo.2011.10.001 · 0.19 Impact Factor
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    ABSTRACT: The association between diabetes and incidence of tuberculosis is well established, and observational studies have shown poor treatment outcome in tuberculosis related to hyperglycemia. The WHO recommends screening for diabetes among all patients with tuberculosis and optimized glycemic control aiming at improving tuberculosis outcome. However, no intervention studies support this notion. Patients with tuberculosis are often vulnerable with high degree of comorbidity, and, therefore, at high risk of adverse effects of intensive glucose control. Controlled intervention studies of the effect of glucose lowering treatment on tuberculosis outcomes are clearly warranted to justify screening for- and tight control of diabetes.
    Current Diabetes Reports 07/2014; 14(7):505. DOI:10.1007/s11892-014-0505-1 · 3.38 Impact Factor

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