Utilização estratégica da genotipagem do Mycobacterium tuberculosis no controlo da tuberculose

 

Strategical use of genotyping of Mycobacterium tuberculosis in tuberculosis control

 

Susana David ¹

 

Resumo

A situação da tuberculose em Portugal justifica a aplicação de uma estratégia de genotipagem do Mycobacterium tuberculosis, tanto mais que Portugal encontra-se inserido no contexto global de mobilidade das populações humanas e das suas consequências sobre a pandemia.

Vários estudos internacionais posicionam as técnicas do spoligotyping e MIRU -VNTR typing como de primeira linha na epidemiologia molecular do M. Tuberculosis por estarem baseadas em tecnologias simples (PCR) e produzirem padrões, podendo ser traduzidos em código numérico de interpretação directa. Assim, tem sido proposta a aplicação do spoligotyping a todos os isolados clínicos, enquanto o MIRU -VNTR typing seria aplicado aos isolados com spoligotype comum. Outras técnicas, incluindo o IS6110 -RFLP, seriam reservadas a aplicações segundo critérios seleccionados.

Os trabalhos anteriores em Portugal utilizando o spoligotyping apontaram para a vantagem de uma estraté-secutiva e sem critério de pré-selecção. Esta permite a caracterização da estrutura populacional do M. Tuberculosis através do conhecimento da distribuição dos genotipos geograficamente, no tempo e dentro dos vários grupos de risco.

Por outro lado, a associação do spoligotyping com o MIRU -VNTR typing e, eventualmente, outras técnicas, deverá ser avaliada em vários contextos, como na identificação de situações de transmissão recente, na distinção entre episódios de reinfecção e recaída, na caracterização da amplitude e dinâmica de transmissão da doença.

A solução do problema da tuberculose em Portugal passa por uma estruturação na utilização da genotipagem em apoio à luta contra a tuberculose, a ser avaliada através de exemplos e resultados concretos.

Palavras-chave: Mycobacterium tuberculosis, Epidemiologia molecular, genotipagem.

 

Abstract

The tuberculosis situation in Portugal justifies the use of a strategy for the genotyping of Mycobacterium tuberculosis,particularly as Portugal is part of the global backdrop of human mobility, something which has a knock-on effect on the pandemic.

Several international studies have placed spoligotyping and MIRU- VNTR typing as first line techniques for the molecular epidemiology of Mycobacterium tuberculosis as these techniques rely on simple technologies (PCR) and produee patterns which are easily translated into a direct interpretation numerical code. Spoligotyping has been accordingly proposed for all the isolates, while MIRU-VNTR typing should be applied to isolates with a common spoliotype.

Other techniques, including IS6110-RFLP, should be reserved for use ill accordance with selected criteria.

Previous studies in Portugal using spoligotyping have underlined the advantages of a strategy based on sampling consecutive patient isolates with no prior selection criteria. This allows characterisation of the M. tuberculosis population structure through monitoring the distribution of the genotypes geographically over time and within the various risk groups.

On the other hand, the association of spoligotyping, MIRU-VNTF (typing and, possibly, other techniques, needs evaluating as part of bigger pictures, including identifying recent transmission situations, distinguishing between reinfection and relapse episodes and ma pping the size and dynamics of disease transmission.

The solution to the tuberculosis problem in Portugal implies structuring genotyping’s role in tuberculosis prevention and control and its evaluation through concrete examples and results.

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

 

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¹ Investigadora Principal

Centro de Tuberculose e Micobactérias

Instituto Nacional de Saúde Dr. Ricardo Jorge

Rua do Campo Alegre 823, 4150-180 Porto

Email: sdavid@ibmc.up.pt

 

Recebido para publicação/received for publication: 08.01.30

Aceite para publicação/accepted for publication: 08.03.26