Transcript INSTITUTO DE INFECTOLOGIA EMÍLIO RIBAS Identification of

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INSTITUTO DE INFECTOLOGIA EMÍLIO RIBAS
Identification of Mycobacterium tuberculosis complex in clinical
specimens of HIV-infected patients at Instituto de Infectologia
Emilio Ribas, São Paulo-Brazil
1
M.Eira ,
1
Boccardo ,
2
Silva ,
2
Barbosa ,
1
Moreira ,
3
Souza ,
E.
R. J. Costa
U.
I.
S. A.
F. I.
Oliveira Junior4; 1Instituto de Infectologia Emílio Ribas, Ambulatory, São Paulo,
2
SP/BR, Instituto de Infectologia Emílio Ribas, Centro de Estudos, Sao Paulo/BR,
3Instituto de Infectologia Emilio Ribas, Clinical Laboratory, São Paulo/BR, 4Instituto
de Infectologia Emilio Ribas, Ambulatory, São Paulo/BR
Background
Tuberculosis (TB) remains the most
common infection among HIV patients.
Currently, the TB diagnosis is still based on
the clinical presentation, radiographic
findings
and
microbiological
results.
Considering the complexities of treating
HIV/TB co-infection,TB diagnosis requires
the availability of diagnostic tools that allow
the rapid detection of Mycobacterium
tuberculosis complex (MTBC) and drug
resistance in clinical samples.
Methods & Materials
In this retrospective study conducted at the
Instituto de Infectologia Emílio Ribas, São
Paulo/BR, we analized a total of 5350
clinical specimens (respiratory and extrapulmonary) collected from patients with
signs and symptoms suggestive of TB from
January/14 to December/14. All samples
were processed by conventional diagnostic
techniques, including smear examination for
acid-fast bacillus (AFB) and cultured in
MGITF-960 automated system. Blood and
bone marrow were cultured in BACTECFX.
Identification of MTBC and non-tuberculous
mycobacteria (NTM) was performed by
rapid immunochromatographic assay. The
average time needed for detection of
mycobacteria was 15 days. Suscetibility
testing for MTBC and PCR for NTM was
performed by Adolfo Lutz Institute, S. Paulo.
Results
Table 1: Clinical and laboratory features in patients
with clinical suspicion of tuberculosis at the Instituto
de Infectologia Emílio Ribas.
Characteristic
Culture for MT
Sociodemographic characteristics
Male
Tuberculosis
Pulmonary
Extrapulmonary
Laboratory features
HIV-infected patients
Positive rapid test for MTBC
Positive rapid test for NTM
Mycobacterium avium complex
Mycobacterium kansasii
Mycobacterium fortuitum
Others Mycobacterium
Resistance for MTBC
Rifampicin
Isoniazid
No. Subjects (%)
554/5350 (10.35)
342/554 (61.73)
398/554 (71.84)
156/554 (28.15)
428/554 (77.25)
391/554 (70.57)
95/554 (17.14)
50/95 (52.48)
15/95 (15.78)
5/95 (5.26)
25/95 (26.31)
25/391 (6.30)
11/25 (44.00)
8/25 (32.00)
Conclusion
TB is a important public health problem and the
diagnosis in HIV-infected patients is challenging. The
use of mycobacterial culture remains an important
diagnostic tool. The immediate future involves rapid
molecular techniques, in particular GeneXpert which
is also able to detect rifampicin resistance. In order to
improve diagnosis and detect as early as possible
resistance to rifampin, it was introduced earlier this
year the GeneXpert MTB/RIF in our hospital which
proposes to be a strong diagnostic tool for pulmonary
TB
Keywords: Tuberculosis
Mycobacterial disease
Drug resistance.
E-mail: [email protected]