Abstract

COSTEIRA, João  and  PINA, Jaime. Multi-drug resistant tuberculosis and the red queen - Diagnosis speed is crucial . Rev Port Pneumol [online]. 2007, vol.13, n.6, pp.869-877. ISSN 0873-2159.

The multi-drug resistant Tuberculosis (MDRTB) is a huge menace to Tuberculosis control. The early detection of MDRTB is essential to best appropriate measures. The detection methods for drug resistance based in evaluation of the genetic determinants (genotypic methods), instead of phenotypic methods, allows for faster results, the possibility of direct application in clinical samples and simultaneous identification of Mycobacterium tuberculosis complex. The inpatients data analysis in the "Serviço de Pneumologia 2 do Hospital Pulido Valente", showed a high prevalence of MDRTB (10.3%). In 34.1% of the MDRTB patients the multi-drug resistance was not been identified, with a mortality ratio in this cases of 31% versus 18.4% in the subset of patients with resistance previously identified. Moreover the mortality ratio was worst in MDRTB/AIDS patients with 50% versus 15%, respectively. Targeting for rapid drug resistance detection, in hospitalized patients at "Serviço de Pneumologia 2 do Hospital Pulido Valente", the test INNO-LIPA Rif.TB, to identify the rifampicin resistance as a marker of multi-drug resistance, was evaluated. The test was performed in 113 samples and had a high ratio of sensitivity (91.6%), specificity (98%), positive predictive value (84, 6%) and negative predictive value (99%). Time to obtain the results was 7.6 days for the genotypic test versus 23.4 days to the phenotypic test (BACTEC MGIT 960). The INNO-LIPA Rif.TB test is, now, performed in every patient with smear-positive Tuberculosis with no previous knows resistance profile, with good outcome.

Keywords : Multi-drug resistant tuberculosis; genotypic method; sensitivity; specificity.

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