Dados do Trabalho

Título

Tuberculosis among young contacts of patients with multidrug resistant pulmonary tuberculosis in a reference hospital in Rio de Janeiro, Brazil

Introdução

The presence of Mycobacterium tuberculosis (MTB) strains resistant to the most effective anti-TB medications poses a significant threat to the elimination of TB. In Brazil, between 2015 and 2023, 17,200 new cases of drug resistant (DR) -TB were reported in the country; of these, 1,060 were diagnosed in 2023, representing an increase of 60.1% compared to those diagnosed in 2018. Children under 5 years old who are contacts of patients with pulmonary TB have an increased risk of tuberculosis infection (TBI) and severe forms of TB disease (TBD). The detection of TBI and its preventive treatment (TPT) with isoniazid and/or rifamycins among close contacts of patients with pulmonary TB represent a public health priority. However, no TPT regimen has proven effective in contact of patients with MDR-TB so far.  

Objetivo (s)

This study aims to evaluate TBI and TBD prevalence in children and adolescents (up to 19 years old) contacts of patients with drug-sensitive and resistant pulmonary TB, as well as the incidence of TBD among contacts exposed and not exposed to isoniazid preventive therapy.

Material e Métodos

We evaluated a retrospective cohort of 439 contacts of patients with pulmonary TB up to 19 years old, screened for TB and TBI in Rio de Janeiro between 2006-2016. They were classified based on the drug resistance pattern of the index case into contacts of patients with MDR-TB and non-MDR-TB. A tuberculin skin test result > 5 mm was considered positive. Preventive therapy with isoniazid was offered to eligible contacts, both contacts of patients with pulmonary MDR-TB and non-MDR-TB. Bivariate and multivariate logistic regressions estimated factors associated with TBI.

Resultados e Conclusão

TBI prevalences were 62% and 68% in contacts of patients with pulmonary non-MDR and MDR-TB, respectively. Tuberculin conversion was higher in contacts of patients with MDR-TB (45.5% vs 17.1%; p= 0.04). TBD incidence rates were 47.7 in contacts of patients with non-MDR and 179.6 per 100,000 person-months in contacts of MDR-TB  (p= 0.65), for a total prevalence of 2.5%. TPT completion rate was 71.5% in contacts of non MDR-TB and 59% in contacts of  MDR-TB; p= 0.04. In the final multivariate-model, the risk of TBI was associated with age of contact (OR 1.13; 95% CI 1.03-1.25), grandparent as the index case (OR 0.33; CI95% 0.12-0.93) and HIV infection (OR 0.28; CI95% 0.12-0.69).  The study identified a high TBI incidence among young contacts of MDR-TB patients, highlighting the urgency of evaluating new TPT regimens for this group of contacts.      

Palavras Chave

Tuberculose; Crianças; Adolescentes; Tratamento preventivo