Evolución de la tuberculosis resistente en la Provincia de Buenos Aires en el período 2006 a 2014

Abstract

La incidencia mundial de tuberculosis (TB) se presenta con una tendencia hacia el descenso a partir del año 2002 en que se viene produciendo una disminución del 1,3% anual. Aunque este hecho es auspicioso, todavía es débil la posibilidad de alcanzar la eliminación para el año 2050, según la meta de la Organización Mundial de la Salud (OMS)1. En la Argentina la notificación de TB también mantiene una tendencia descendente, lenta pero sostenida en el tiempo. La velocidad de descenso de la notificación del total de casos nuevos aumentó en la última década, principalmente por el descenso de los casos en niños y en mayores de 65 años, tanto a nivel nacional como provincial.

Introduction: During the last years, Argentina has been maintaining slow but progressive decreasing trends of tuberculosis (TB) incidence rates. In sanitary terms, the drug-resistant forms of the disease are complicating the global control of the disease. Objetive: The main objectives of this study were to describe the incidence of multi and extensive drug-resistant TB (M/XDR) in children and adults, to analyze its transmission within contacts and the relationship with previous treatments. Materials and methods: During 2006-2014 it was notified to the Control Program of Buenos Aires Province 41,782 TB cases, 5.712 (13.7%) children <15 years old, 35.843 (85.8%) adults; 35,862 (85.8%) patients presented a respiratory form of the disease, 24,913 (69.5%) confirmed by bacteriology, 21,842 (87.7%) by microscopy examination. Results: They were diagnosed 636 cases of drug-resistant TB: 445 (70.0%) MDR TB, 13 (2.9%) children; 18 (2.6%) had a XDR pattern; from 109 (24.5%) individuals the bacteria showed a MDR pattern also resistant to fluoroquinolones or an injectable agent (amikacin, kanamicin or capreomicin). Besides, 64 cases suspected of being MDR were resistant to one or more drugs not accomplishing the MDR criterion. Eighty two (18.4%) patients with M/XDR had their first TB episode being 20 of them, 9 children, contacts of previous TB cases; 19 individuals were considered index cases of another 31 contacts that developed also M/XDR TB. Discussion: Transmission from index cases to contacts was demonstrated by molecular and classical epidemiology. The isolates fingerprinting and the diagnosis of TB dates were useful tools to trace the epidemiologic infection route.