European Society of Mycobacteriology - Instituto Nacional de Saúde ...

PP-28
MULTIDRUG-RESISTANT TUBERCULOSIS
Nuak, Joao; Ferreira, Danina; Carvalho, Teresa; Gomes, Maria Helena; Sarmento, Antonio
Hospital S. Joao, Porto - Portugal
Introduction
Multidrug-Resistant Tuberculosis (MDRTB) is caused by M.tuberculosis (MT) resistant to at least Isoniazid (INZ) and
Rifampin (RIF), and can be due to unsuitable or irregular treatment.
Purpose
To know the epidemiological and clinical characteristics of the disease in patients (pts) hospitalized with MDRTB in an
Infectious Diseases Service.
Patients And Methods
Review of clinical records of pts with MDRTB. Diagnosis was based on drug susceptibility testing.
Results
Between 1996 and 2007, 16 pts had MDRTB. Eleven were male. Ages ranged between 27-40y(X=32.2±4.33). Fifteen
(93.8%) had HIV infection (14 drug addicts; 1 sexual risk). One pt had professional contact with MDRTB. The disease was
only pulmonary in 7(44%) pt, disseminated in 5(31%), pulmonary and extra-pulmonary in 3(19%)-meningeal, lymph nodes
(LN) and urine in one each pt; another pt had only meningeal disease. Eleven (69%) pts had previous irregular antituberculosis
treatment. MT was isolated in sputum in 12/16 pt (75%); CSF in 5/6 pt (83%), bronchoalveolar lavage in 2/6(33%),
blood in 3/6(50%), urine in 2/6(33%), LN in 2/6(33%), gastric aspirate and feces in one each. Most pts had MT isolated in
more than one sample. All MT were resistant to INZ and RIF. Thirteen out of 16 pt (81%) were also resistant to streptomycine,
6/12(50%) to pyrazinamide, 6/16(37%) to ethambutol, 5/12(42%) to rifabutine, 10/15(67%) to ethionamide,
4/14(28%) to kanamycin, 4/13(31%) to ofloxacilline, 3/7(43%) to PAS, 2/5(40%) to kapriomycine e 1/5(20%) to cyclocerin.
In 4 pts MT was simultaneously resistant to at least three 2nd line drugs (XDRTB). Fifteen pts had medical treatment according
to the drug susceptibilities testing. In two pts pneumectomy was performed. Eight pts died: One before diagnosis
and 7 between 30-720 days of diagnosis. One pt survived for 6y. maintaining positive cultures of sputum despite medical
and surgical therapy. Two pts were treated for 18 months with clinical and radiological improvement, without evidence of
disease 1 and 5y. later. Five pts were lost to follow-up. One is on treatment with clinical and radiological improvement.
Conclusion
MDRTB is a serious public health problem. HIV, drug addiction and irregular treatment were important factors for its
development. Prognosis depends on early detection of drug resistance and institution of appropriate therapy. We emphasize
the very high mortality.
100 ESM 2009