Article

Fatores de risco para a recidiva da tuberculose

Jornal Brasileiro De Pneumologia - J BRAS PNEUMOL 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 - J BRAS PNEUMOL. 01/2007; 33(5).
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    Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 11/2007; 33(5):xxvii-xxviii.
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    ABSTRACT: To propose a tuberculosis-related death surveillance strategy based on the Brazilian Mortality Information System. Data on 55 tuberculosis-related deaths, which occurred in two large hospitals in Rio de Janeiro, Southeastern Brazil, between September 2005 and August 2006, were obtained from the SIM. These cases were searched and compared with cases in the National Notification System (Sinan). The increment in the number of notifications and completeness of data were evaluated, as well as entry type and outcome in Sinan. Of the 55 deaths, 28 were registered in Sinan. Comparison between systems allowed for the following corrections: 27 new cases were notified, 14 new notifications performed by the hospitals where death occurred and ten outcomes corrected. This represented an increment of 41/144 (28%) notifications by these two hospitals in 2006. Nine cases, previously classified as unconfirmed tuberculosis were reclassified as bacteriologically confirmed, and another five cases were reclassified from tuberculosis to AIDS as the primary cause of death. The proposed surveillance system for tuberculosis-related death was useful to increase data completeness, decrease under-notification and cases with unknown outcome, to evaluate epidemiological surveillance and death certificate quality and to trace previously unidentified contacts.
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May 21, 2014