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Perfil dos doentes com tuberculose multirresistente registados no Hospital Sanatório de Luanda entre janeiro de 2015 e junho de 2016
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RESUMO - Introdução: A tuberculose multirresistente é uma doença infeciosa causada por
estirpes de Mycobaterium tuberculosis que são resistentes à pelo menos à Isoniazida
e à Rifampicina. Continua a ser um grande problema de saúde pública em muitos
países e está ameaçando desestabilizar o controlo global da TB. As técnicas
moleculares fornecem o diagnóstico de TB-MR em poucas horas e são usadas com
sucesso mesmo em situações em que os recursos são escassos, como no caso do
hospital sanatório de Luanda. Este estudo tem como finalidade consciencializar os
profissionais de saúde sobre o perfil e as características de pacientes com TB-MR,
para que possam melhor entender a sua magnitude, e estar alerta com maior
sensibilidade para diagnosticar precocemente os pacientes afetados para evitar a
progressão da doença e a sua disseminação na comunidade. O objetivo geral deste
estudo é de caracterizar os doentes de TB-MR diagnosticados entre janeiro 2015 e
junho 2016 no Hospital Sanatório de Luanda, considerando características
sociodemográficas, clínicas e comportamentais. Adicionalmente, é também objetivo
deste estudo caracterizar os fatores de riscos associados ao resultado terapêutico,
focando no abandono terapêutico.
Material e Métodos: foi realizado um estudo quantitativo, observacional e transversal,
em que a unidade de observação foi o Hospital Sanatório de Luanda, localizado em
Angola. O estudo incluiu 121 pacientes com tuberculose pulmonar multirresistente com
resultado terapêutico curado ou abandono, registados para tratamento no Hospital
Sanatório de Luanda no período de 01 de janeiro de 2015 a 30 de junho de 2016. Para
a realização deste estudo foram usadas variáveis qualitativas (nominais e ordinais) e
numéricas. No princípio foram considerados 49 variáveis e ao longo de estudo não
foram consideradas 14 variáveis por terem mais de 50% de valores omisso. Os dados
obtidos foram registados numa matriz de dados desenvolvidos para o efeito e
analisados, utilizando a estatística descritiva e aplicação do teste de independência do
Qui-quadrado.
Resultados: considerando as características de pacientes, a idade media é de 33
anos, a mediana é de 30 anos, a moda é de 30, e desvio padrão é de 13,36, com uma
idade mínima de 2 anos e máxima de 83 anos. O sexo masculino foi o mais frequente
(66,94%) em relação ao sexo feminino (33,06%). O município de Luanda é o que
apresenta uma maior proporção de pacientes (28,09%). 97,52% de pacientes TB-MR
detetados são classificados como casos de resistência secundária, 79,09% de
pacientes com TB-MR apresentaram uma baciloscopia positiva; 89,09% de pacientes com TB-MR são seronegativos ao VIH; 97,01% de pacientes com TB-MR não têm
história de TB-MR na família; 58,75% de pacientes com TB-MR abusavam com álcool;
80,88% de pacientes com TB-MR não são fumadores; 2,99% faziam uso abusivo de
drogas. Considerando a caracterização de pacientes relacionada com fatores de riscos
associados ao resultado terapêutico, em geral houve 121 casos, sendo 48 (39,7%)
pacientes curados e 73 (60,3%) pacientes abandonaram o tratamento.
O estudo revelou uma proporção elevada de abandono em relação aos curados, há
ausência da relação entre a distância de residência e o local de tratamento, 10,91% de
casos de TB-MR são seropositivos por VIH. O atraso no diagnóstico, o tempo de
doença prévia, a duração de tratamento da segunda linha (24 meses) e o abuso de
álcool foram notados como fatores associados ao abandono do tratamento.
Conclusões: Respondendo ao primeiro objetivo relacionado com a caracterização dos
doentes de TB-MR, o estudo revelou que: o sexo mais afetado é o sexo masculino, a
idade media é de 33 anos, os municípios de Luanda e de Viana apresentam uma
maior proporção de pacientes, a frequência de pacientes com a duração de doença há
mais de um ano é maior em relação aos que têm a doença há menos de um ano,
pacientes classificados previamente no esquema terapêutico da categoria 2 foram
maiores do que pacientes classificados em categoria 1, a frequência de pacientes com
fracasso no tratamento antibacilar da primeira linha é maior em relação aos pacientes
com fracasso no tratamento antibacilar da segunda linha, 97,50% de pacientes TB-MR
são classificados como casos de resistência secundária, uma proporção maior de
pacientes com TB-MR são seronegativos ao VIH, a comorbidade por Diabetes Mellitus
neste estudo é de 2,73%, mais pacientes com TB-MR apresentaram uma baciloscopia
negativa.
Respondendo ao segundo objetivo relacionado com os fatores de riscos associados
ao resultado terapêutico, o estudo revelou que houve muitos pacientes de sexo
masculino a abandonar o tratamento em relação aos pacientes de sexo feminino, a
distancia entre a residência do paciente e o HSL não influenciou o abandono de
tratamento, a taxa de sucesso terapêutica foi de 39,70%, e a taxa de abandono foi de
60,30%, muitos casos de abandonos tinham a baciloscopia positiva, nota-se uma
percentagem elevada (66%) de abandonos que fazem uso abusivo de álcool.
Este conhecimento pode promover uma maior consciência por parte dos profissionais
de saúde para um diagnóstico mais rápido e um tratamento mais eficaz.
ABSTRACT - Introduction: Multidrug-resistant tuberculosis is an infectious disease caused by strains of Mycobacterium tuberculosis that are resistant to at least Isoniazid and Rifampicin. It remains a major public health problem in many countries and is threatening to destabilize global TB control. Molecular techniques provide the diagnosis of MR-TB in a few hours and are used successfully even in situations where resources are scarce, as in the case of the sanatorium hospital in Luanda. This study aims to raise the awareness of health professionals about the profile and characteristics of patients with MR-TB so that they can better understand its magnitude and be alert with greater sensitivity to diagnose patients affected early to prevent disease progression and its dissemination in the community. The general objective of this study is to characterize patients with MR-TB diagnosed between January 2015 and June 2016 at the Luanda Sanatorium Hospital, considering sociodemographic, clinical and behavioral characteristics. In addition, it is also the objective of this study to characterize the risk factors associated with the therapeutic result, focusing on therapeutic abandonment. Material and Methods: A quantitative, observational and cross-sectional study was carried out, in which the observation unit was the Luanda Sanatorium Hospital, located in Angola. The study included 121 patients with multiresistant pulmonary tuberculosis with cured or abandoned treatment, registered for treatment at the Hospital Sanatorium of Luanda from January 1, 2015, to June 30, 2016. For the purpose of this study, qualitative (nominal) variables and ordinal) and numerical. In the beginning, 49 variables were considered and during the study, 14 variables were not considered because they had more than 50% of values missing. The obtained data were recorded in a matrix of data developed for the purpose and analyzed, using the descriptive statistics and application of the test of independence of the Chi-square. Results: Considering the characteristics of patients, the mean age is 33 years, the median is 30 years, the fashion is 30, and the standard deviation is 13.36, with a minimum age of 2 years and a maximum of 83 years. The male sex was the most frequent (66.94%) in relation to the female sex (33.06%). The municipality of Luanda has the highest proportion of patients (28.09%). 97.52% of detected MR-TB patients are classified as secondary resistance cases, 79.09% of patients with MR-TB had a positive bacilloscopy; 89.09% of MR-TB patients are seronegative to HIV; 97.01% of MR-TB patients do not have a history of MDR-TB in the family; 58.75% of patients with MR-TB abused with alcohol; 80.88% of patients with MR-TB are not smokers; 2.99% were drug abusers. Considering the characterization of patients related to risk factors associated with the therapeutic result, in general, there were 121 cases, of which 48 (39.7%) patients were cured and 73 (60.3%) patients abandoned treatment. The study revealed a high rate of dropout compared to the cured. There is no relationship between the distance of residence and the treatment site, 10.91% of MRTB cases are HIV-positive. Delay in diagnosis, time of previous illness, duration of second-line treatment (24 months) and alcohol abuse were noted as factors associated with treatment withdrawal. Conclusions: Responding to the first objective related to the characterization of MR-TB patients, the study revealed that: the sex most affected is males, the mean age is 33 years, the municipalities of Luanda and Viana have a higher proportion of patients , the frequency of patients with a disease duration of more than one year is higher than those with the disease for less than one year, patients classified previously in the category 2 treatment regimen were larger than patients classified in category 1, frequency of patients with failed first-line antibiotic treatment is greater than patients with failure in second-line anti-TB treatment, 97.50% of MR-TB patients are classified as secondary resistance, a higher proportion of patients with TB -MR are seronegative to HIV, the comorbidity for Diabetes Mellitus in this study is 2.73%, more patients with MR-TB had a negative bacilloscopy. Responding to the second objective related to risk factors associated with therapeutic outcome, the study revealed that there were many male patients withdrawing from treatment in relation to female patients, the distance between the patient's residence and the HSL did not influence the treatment success rate was 39.70%, and the dropout rate was 60.30%, many cases of withdrawal had positive bacilloscopy, a high percentage (66%) of making abusive use of alcohol. This knowledge can promote greater awareness on the part of health professionals for a faster diagnosis and a more effective treatment.
ABSTRACT - Introduction: Multidrug-resistant tuberculosis is an infectious disease caused by strains of Mycobacterium tuberculosis that are resistant to at least Isoniazid and Rifampicin. It remains a major public health problem in many countries and is threatening to destabilize global TB control. Molecular techniques provide the diagnosis of MR-TB in a few hours and are used successfully even in situations where resources are scarce, as in the case of the sanatorium hospital in Luanda. This study aims to raise the awareness of health professionals about the profile and characteristics of patients with MR-TB so that they can better understand its magnitude and be alert with greater sensitivity to diagnose patients affected early to prevent disease progression and its dissemination in the community. The general objective of this study is to characterize patients with MR-TB diagnosed between January 2015 and June 2016 at the Luanda Sanatorium Hospital, considering sociodemographic, clinical and behavioral characteristics. In addition, it is also the objective of this study to characterize the risk factors associated with the therapeutic result, focusing on therapeutic abandonment. Material and Methods: A quantitative, observational and cross-sectional study was carried out, in which the observation unit was the Luanda Sanatorium Hospital, located in Angola. The study included 121 patients with multiresistant pulmonary tuberculosis with cured or abandoned treatment, registered for treatment at the Hospital Sanatorium of Luanda from January 1, 2015, to June 30, 2016. For the purpose of this study, qualitative (nominal) variables and ordinal) and numerical. In the beginning, 49 variables were considered and during the study, 14 variables were not considered because they had more than 50% of values missing. The obtained data were recorded in a matrix of data developed for the purpose and analyzed, using the descriptive statistics and application of the test of independence of the Chi-square. Results: Considering the characteristics of patients, the mean age is 33 years, the median is 30 years, the fashion is 30, and the standard deviation is 13.36, with a minimum age of 2 years and a maximum of 83 years. The male sex was the most frequent (66.94%) in relation to the female sex (33.06%). The municipality of Luanda has the highest proportion of patients (28.09%). 97.52% of detected MR-TB patients are classified as secondary resistance cases, 79.09% of patients with MR-TB had a positive bacilloscopy; 89.09% of MR-TB patients are seronegative to HIV; 97.01% of MR-TB patients do not have a history of MDR-TB in the family; 58.75% of patients with MR-TB abused with alcohol; 80.88% of patients with MR-TB are not smokers; 2.99% were drug abusers. Considering the characterization of patients related to risk factors associated with the therapeutic result, in general, there were 121 cases, of which 48 (39.7%) patients were cured and 73 (60.3%) patients abandoned treatment. The study revealed a high rate of dropout compared to the cured. There is no relationship between the distance of residence and the treatment site, 10.91% of MRTB cases are HIV-positive. Delay in diagnosis, time of previous illness, duration of second-line treatment (24 months) and alcohol abuse were noted as factors associated with treatment withdrawal. Conclusions: Responding to the first objective related to the characterization of MR-TB patients, the study revealed that: the sex most affected is males, the mean age is 33 years, the municipalities of Luanda and Viana have a higher proportion of patients , the frequency of patients with a disease duration of more than one year is higher than those with the disease for less than one year, patients classified previously in the category 2 treatment regimen were larger than patients classified in category 1, frequency of patients with failed first-line antibiotic treatment is greater than patients with failure in second-line anti-TB treatment, 97.50% of MR-TB patients are classified as secondary resistance, a higher proportion of patients with TB -MR are seronegative to HIV, the comorbidity for Diabetes Mellitus in this study is 2.73%, more patients with MR-TB had a negative bacilloscopy. Responding to the second objective related to risk factors associated with therapeutic outcome, the study revealed that there were many male patients withdrawing from treatment in relation to female patients, the distance between the patient's residence and the HSL did not influence the treatment success rate was 39.70%, and the dropout rate was 60.30%, many cases of withdrawal had positive bacilloscopy, a high percentage (66%) of making abusive use of alcohol. This knowledge can promote greater awareness on the part of health professionals for a faster diagnosis and a more effective treatment.
Descrição
Palavras-chave
Tuberculose multirresistente Perfil epidemiológico Hospital Sanatório de Luanda Multidrug-resistant tuberculosis Epidemiological profile Sanatorium of Luanda