SciELO - Scientific Electronic Library Online

 
vol.14 número2Hábitos tabágicos e conhecimento dos riscos do tabagismo em função da formação académica em estudantes universitáriosCancro do pulmão: Aspectos psicológicos e psiquiátricos índice de autoresíndice de assuntosPesquisa de artigos
Home Pagelista alfabética de periódicos  

Serviços Personalizados

Journal

Artigo

Indicadores

Links relacionados

  • Não possue artigos similaresSimilares em SciELO

Compartilhar


Revista Portuguesa de Pneumologia

versão impressa ISSN 0873-2159

Rev Port Pneumol v.14 n.2 Lisboa mar. 2008

 

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.

 

 

Texto completo disponível apenas em PDF.

Full text only available in PDF format.

 

 

Bibliografia / Bibliography

1. Direcção Geral de Saúde. Programa Nacional de Luta Contra a Tuberculose. Ponto da situação epidemiológica e de desempenho. 2003.        [ Links ]

2. van Embden JD, Cave MD, Crawford JT, et al. Strain identification of Mycobacterium tuberculosis by DNA fingerprinting: recommendations for a standardized methodology. J Clin Microbiol 1993;31:406 -9.

3. van Soolingen D. Molecular epidemiology of tuberculosis and other mycobacterial infections: main methodologies and achievements. J Intern Med 2001;249:1 -26.

4. Yang ZH, Bates JH, Eisenach KD, Cave MD. Secondary typing of Mycobacterium tuberculosis isolates with matching IS6110 fingerprints from different geographic regions of the United States. J Clin Microbiol 2001;39:1691 -5.

5. Kremer K, van Soolingen D, Frothingham R, et al. Comparison of methods based on different molecular epidemiological markers for typing Mycobacterium tuberculosis complex strains: inter-laboratory study of discriminatory power and reproducibility. J Clin Microbiol 1999;37:2607 -18.

6. Kamerbeek J, Schouls L, Kolk A, et al. Rapid detection and simultaneous strain differentiation of Mycobacterium tuberculosis for diagnosis and tuberculosis control. J Clin Microbiol 1997;35:907 -14.

7. Portugal I, Covas MJ, Brum L, et al. Outbreak of multiple drug-resistant tuberculosis in Lisbon: detection by restriction fragment length polymorphism analysis. Int J Tub Lung Dis 1999;3:207 -13.

8. David H, Levy-Frébault V, Thorel MF. Méthodes de laboratoire pour mycobactériologie clinique. 1989 Institut Pasteur, Paris.

9. Hermans P W, Messadi F, Guebrexabher H, et al. Usefulness of DNA typing for global tuberculosis epidemiology. J Inf Dis 1995;171:1504 -13.

10. Murray M, Alland D. Methodological problems in the molecular epidemiology of tuberculosis. Am J Epidemiol 2000;155: 565 -71.

11. van Soolingen D, Borgdorff MW, de Haas PEW, et al. Molecular epidemiology in the Netherlands: a nation-wide study from 1993 trough 1997. J Inf Dis 1999; 180: 726 -736.

12. Murray M, Nardell E. Molecular epidemiology of tuberculosis: achievements and challenges to current knowledge. Bull World Health Organ 2002;80:477 -82.

13. Bauer J, Yang Z, Poulsen S, Andersen AB. Results from 5 y of nation -wide DNA fingerprint of Mycobacterium tuberculosis complex isolates in a country with a low incidence of Mycobacterium tuberculosis infection. J Clin Microbiol 1998;36:305 -8.

14. van Soolingen D, Hermans P W, de Haas PEW, Soll D R, van Embden J D A. Occurrence and stability of insertion sequences in Mycobacterium tuberculosis complex strains: evaluation of insertion sequence–dependent DNA polymorphism as a tool in the epidemiology of tuberculosis. J Clin Microbiol 1991;29:2578 -86.

15. Small PM, Hopewell PC, Singh SP, et al. The epidemiology of tuberculosis in San Francisco. N Engl J Med 1994;330:1703 -9.

16. Direcção Geral de Saúde. Programa Nacional de Luta Contra a Tuberculose. Ponto da situação epidemiológica e de desempenho. 2002.

17. Yeh RW, Ponce de León A, Agasino CB, et al. Stability of Mycobacterium tuberculosis DNA genotypes. J Infect Dis 1998;177:1170 -1111.

18. Glynn J R, Whiteley J, Bifani P J, Kremer K, van Soolingen D. Worldwide occurrence of Beijing/W strains of Mycobacterium tuberculosis: a systematic review. Emerg Infect Dis 2002;8:843 -9.

19. Lillebaek T, Dirksen A, Kok -Jensen A, Andersen A.B. A dominant Mycobacterium tuberculosis strain emerging in Denmark. Int J Tuberc Lung Dis 2004;8:1001 -6.

20. Victor T C, de Haas P, Jordaan A, et al. Warren R. Molecular characteristics and global spread of Mycobacterium tuberculosis with a Western Cape F11 genotype. J Clin Microbiol 2004;42:769 -72.

21. Blackwood K, Al -Azem A, Elliott L, Hershfield E, Kabani A. Conventional and molecular epidemiology of tuberculosis in Manitoba. BMC Infect Dis 2003;3:1 -11.

22. Hermans P W, Messadi F, Guebrexabher H, et al. Analysis of the population structure of Mycobacterium tuberculosis in Ethiopia, Tunisia, and The Netherlands: usefulness of DNA typing for global tuberculosis epidemiology. J Infect Dis 1995;171:1504 -13.

23. Chevrel -Dellagi D, Abderrahman A, Haltiti R, Koubaji H, Gicquel B, Dellagi K. Large-scale DNA fingerprinting of Mycobacterium tuberculosis strains as a tool for epidemiological studies of tuberculosis. J Clin Microbiol 1993;31:2446 -50.

24. World Health Organization. Anti-tuberculosis drug resistance in the World. Report No.2: Prevalence and trends. 2000. WHO/CDS/TB/2000.278. Geneva: WHO, 2000.

25. World Health Organization. Anti-tuberculosis drug resistance in the World. Report No.3. 2004. WHO/, Geneva: WHO, 2004.

 

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