Tuberculose extrapulmonar : uma abordagem epidemiológica e molecular

• Autor(a) principal: Gomes, Teresa
• Data de Publicação: 2013
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da Universidade Federal do Espírito Santo (riUfes)
• Texto Completo: http://repositorio.ufes.br/handle/10/4557
• topic: Extrapulmonary tuberculosis; Molecular epidemiology; Spatial analysis; Epidemiological surveillance; Tuberculose extrapulmonar; Epidemiologia molecular; Doenças Infecciosas e Parasitárias; Tuberculose; Análise espacial (Estatística); Vigilância epidemiológica; Epidemiologia; 61

Introduction: Extrapulmonary tuberculosis (EPTB) is less frequent and less addressed by control programs of tuberculosis (TB), besides having its determinants not fully elucidated in the literature. Objective: This study aimed to analyse the epidemiological (sociodemographic and clinical), molecular and spatial characteristics of EPTB in Brazil, in Espírito Santo, state (ES) and in Vitória, city, respectively. Data were extracted of laboratory records and SINAN (Information System for Notifiable Diseases). Results: It`s a cross-sectional descriptive and comparative study [EPTB compared to pulmonary TB (PTB)] between 2007 and 2011. It were reported in Brazil 53 853 (12.60% 95% 12.49% - 12.69%) cases of EPTB, the main sites affected were pleural (42%) and lymph node (21%). When compared with PTB, the EPTB was associated with less than 7 years old, white skin, higher educational level, and co-infection with HIV. Since alcohol use, diabetes and mental illness were mainly associated with TBP. The outcome was present more healing (73%), having a greater number of transfers and fewer MDRTB (multi-drug resistant TB) compared to PTB. In ES, state 612 isolates of Mycobacterium tuberculosis (MTB) were genotyped by technique of spoligotyping and restriction fragment length polymorphism - RFLP of the insertion element IS6110. Of the 606 patients included, 79 (13.0% 95% 10.4% - 15.9%) had EPTB. Among the extrapulmonary sites, 42% were lymph node TB and 27% pleural TB. IS6110 RFLP analysis showed that 250 (41%) MTB isolates belonged to 73 clusters, suggesting recent transmission, 27 (11%) of them were isolates of EPTB. The spoligotyping analysis demonstrated 506 (83%) isolates with known patterns and 106 (17%) with unknown patterns. They belonged predominantly to LAM family - 297 (48%). In logistic regression, the variables education (less than 7 years), white skin and HIV ( Human Immunodeficiency Virus) infection were associated with EPTB, but the lineage-specific strain of MTB, the presence of RdRio sublineage and the percentage of cluster were not associated with EPTB. Finally there was a spatial analysis in Vitória, city with EPTB cases that had IS6110 RFLP performed. They were divided into two groups: "EPTB- clustered" and "EPTB non-clustered ". 58 cases were identified, 19 in cluster and 39 non-cluster. EPTB cases were predominantly clustered in the Centre Administrative Region, with a spatial grouping of 900 meters, by the graph of K function, which was suggestive of a spatial concentration of strains by recent transmission. Conclusions: Our study showed factors associated with EPTB in Brazil, ES, state and its capital Vitoria. It was noted that characteristics related to EPTB often differ from those related to PTB, and those reported in low TB burden countries further by a laboratory-based study in the ES, state wasn`t possible to demonstrate relationship of MTB lineage or percentage of cluster and EPTB. Finally, the spatial analysis integrated with molecular biology could highlight areas with EPTB suggestive of recent transmission in Vitória. These results are relevant to understanding the magnitude of EPTB in ES and Brazil.