Epidemiologia molecular de Mycobacterium tuberculosis em Lisboa

 

Molecular epidemiology of Mycobacterium tuberculosis in Lisbon

 

Isabel Portugal¹

Luís Barreiro²

Tiago Vultos²

Rita Macedo³

Cristina Furtado⁴

António Fonseca Antunes⁵

Laura Brum⁶

 

Resumo

Foi realizado um estudo de epidemiologia molecular a estirpes de Mycobacterium tuberculosis isoladas em hospitais de Lisboa. Analisaram-se geneticamente os isolados de Mycobacterium tuberculosis com o método restriction fragment length polymorphism (RFLP) utilizando a sequência de inserção IS6110 como sonda, com o objectivo de detectar as estirpes da família Lisboa e determinar a diversidade genética das estirpes de Mycobacterium tuberculosis isoladas em Lisboa, identificando os mais importantes factores de risco de transmissão da tuberculose.

Foram analisados 290 isolados de Mycobacterium tuberculosis, dos quais 64,8% se encontraram agrupados em clusters; mesmo excluindo as estirpes que apresentaram mais de 5 cópias de IS6110, a percentagem de agrupamento foi de 60,7%. A multirresistência foi observada em 4,1% das estirpes e encontraram-se todas em clusters. Quarenta e cinco isolados (18,2%) pertenciam à família Lisboa. Considerando a percentagem relativamente alta de estirpes em cluster detectada neste estudo, cremos que a transmissão activa continua a ser uma realidade em Lisboa. Para além disso, as estirpes dos clusters Lisboa representam as estirpes predominantes que circulam em Lisboa. Continuando muito relacionadas com a resistência aos antibacilares, embora correspondam a uma percentagem inferior à verificada em estudos anteriores.

Palavras-chave: Mycobacterium tuberculosis, multirresistência, epidemiologia molecular.

 

Abstract

We conducted a molecular epidemiology study of Mycobacterium tuberculosis strains isolated from patients in Lisbon hospitals. We used restriction fragment length polymorphism (RFLP) to detect Lisbon family strains and to determine the genetic diversity of Mycobacterium tuberculosis strains isolated in Lisbon, through identification of the most important risk factors of tuberculosis transmission analysis, with the insertion sequence IS6110 as a probe to fingerprint isolates of Mycobacterium tuberculosis. 64.8% of the 290 Mycobacterium tuberculosis isolates were grouped in clusters. This figure was 60.7% if we excluded strains with five or fewer IS6110 copies. Multidrug-resistance was observed in 4.1% of the strains and they were all in clusters. Forty-five (18.2%) strains were included in the Lisbon family. Considering the relatively high percentage of strains in cluster detected in this study, we believe that active transmission is still taking place in Lisbon. Moreover, clusters of Lisbon strains represent the predominant strains circulating in Lisbon and are still related to drug resistance although presenting a lower percentage than that observed in previous studies.

Key-words: Mycobacterium tuberculosis, multidrugresistance, molecular epidemiology.

 

 

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¹ Professora Auxiliar da Faculdade de Farmácia da Universidade de Lisboa. Investigadora Visitante de Instituto Nacional de Saúde Dr. Ricardo Jorge, Centro de Patogénese Molecular, Faculdade de Farmácia da Universidade de Lisboa, Portugal. Unidade de Micobactérias, Centro de Bacteriologia, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal / Assistant Professor, Molecular Pathogenesis Centre, University of Lisbon School of Pharmacy. Guest Researcher, Micobacteria Unit, Bacteriology Centre, Dr Ricardo Jorge National Institute of Health, Lisbon, Portugal

² Licenciado em Engenharia Biotecnológica, Unidade de Micobactérias, Centro de Bacteriologia, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal / BSc, Biotechnological Engineering, Micobacteria Unit, Bacteriology Centre, Dr Ricardo Jorge National Institute of Health, Lisbon, Portugal

³ Licenciada em Química, Ramo de Bioquímica. Aluna de Mestrado em Microbiologia Clínica. Direcção-Geral de Saúde, Lisboa, Portugal / BSc, Chemistry (Biochemistry). Clinical Microbiology MSc student

⁴ Licenciada em Ciências Farmacêuticas. Aluna de Doutoramento em Epidemiologia da Tuberculose; Unidade de Micobactérias, Centro de Bactereologia, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal / BSc, Pharmaceutical Sciences. Tuberculosis Epidemiology PhD student. Micobacteria Unit, Bacteriology Centre, Dr Ricardo Jorge National Institute of Health, Lisbon, Portugal

⁵ Direcção-Geral de Saúde, Lisboa, Portugal / Directorate-General for Health

⁶ Professora Auxiliar Convidada da Faculdade de Ciências Médicas da Universidade Nova de Lisboa. Assessora de Bacteriologia do Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal. Unidade de Micobactérias, Centro de Bacteriologia, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal / Guest Assistant Professor, University of Lisbon School of Medical Sciences. Bacteriology Assistant, Micobacteria Unit, Bacteriology Centre, Dr. Ricardo Jorge National Institute of Health, Lisbon, Portugal

 

Recebido para publicação/Received for publication: 07.10.08

Aceite para publicação/accepted for publication: 07.12.17