Browsing by Author "Figueredo, Lida Jouca de Assis"

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    Characterization of Mycobacterium tuberculosis heteroresistance by genotyping.
    (2020) Figueredo, Lida Jouca de Assis; Almeida, Isabela Neves de; Augusto, Claudio José; Soares, Valéria Martins; Suffys, Philip Noel; Carvalho, Wânia da Silva; Miranda, Silvana Spíndola de
    Background: Heteroresistance is the coexistence of susceptible and resistant strains in the same individual, considered the preliminary step for total resistance, and can stem from mixed infection or clonal heterogeneity. The aim of this study was to evaluate the heteroresistance of Mycobacterium tuberculosis to rifampicin and isoniazid and its characterization. Method: GenoType MTBDRplus®; Sanger sequencing of the rpoB, katG, and inhA genes; and Mycobacterial Interspersed Repetitive Unit – Variable Number Tandem Repeat (MIRU-VNTR) were performed. Results: In a total of 654 isolates, 530 were resistant, 124 were susceptible, and 29 were heteroresistant to a first-line drug. GenoType MTBDRplus® detected heteroresistance in the rpoB gene in 26/29 (89.6%), as compared to 5/29 (17.2%) in the katG gene and 2/29 (6.8%) in the inhA gene. Four isolates showed heteroresistance in these genes. The Sanger sequencing detected heteroresistance in the rpoB gene in 7/29 (24.1%), as compared to 3/29 (10.3%) in the katG gene. In one isolate, heteroresistance was concomitant in both the rpoB and katG genes. MIRU-VNTR detected mixed infection in three heteroresistant isolates, while four isolates showed clonal heterogeneity. Conclusions: GenoType MTBDRplus® detected more cases of heteroresistance when compared to sequencing. It was also possible to characterize mixed infection and clonal heterogeneity by MIRU-VNTR.
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    Cost analysis of smear microscopy and the Xpert assay for tuberculosis diagnosis : average turnaround time.
    (2020) Figueredo, Lida Jouca de Assis; Miranda, Silvana Spíndola de; Santos, Lucas Benício dos; Manso, Caroline Gontijo Gonçalves; Soares, Valéria Martins; Alves, Suely; Vater, Maria Cláudia; Kritski, Afrânio Lineu; Carvalho, Wânia da Silva; Pádua, Cristiane Menezes de; Almeida, Isabela Neves de
    Introduction: Rapid and accurate tuberculosis detection is critical for improving patient diagnosis and decreasing tuberculosis transmission. Molecular assays can significantly increase laboratory costs; therefore, the average time and economic impact should be evaluated before implementing a new technology. The aim of this study was to evaluate the cost and average turnaround time of smear microscopy and Xpert assay at a university hospital. Methods: The turnaround time and cost of the laboratory diagnosis of tuberculosis were calculated based on the mean cost and activity based costing (ABC). Results: The average turnaround time for smear microscopy was 16.6 hours while that for Xpert was 24.1 hours. The Xpert had a mean cost of USD 17.37 with an ABC of USD 10.86, while smear microscopy had a mean cost of USD 13.31 with an ABC of USD 6.01. The sensitivity of smear microscopy was 42.9% and its specificity was 99.1%, while the Xpert assay had a sensitivity of 100% and a specificity of 96.7%. Conclusions: The Xpert assay has high accuracy; however, the turnaround time and cost of smear microscopy were lower than those of Xpert.
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    Detection of drug resistant mycobacterium tuberculosis strains using Kit SIRE Nitratase® : a multicenter study.
    (2020) Miranda, Silvana Spindola de; Almeida, Isabela Neves de; Mansur, Maria de Fátima Filardi Oliveira; Figueredo, Lida Jouca de Assis; Carvalho, Wânia da Silva; Hadaad, João Paulo Amaral; Diniz, Jaciara de Lourdes do Carmo Guimarães; Groll, Andrea von; Silva, Pedro Almeida da; Lopes, Maria Luiza; Santos, Marcelo Cordeiro dos; Brito, Alexandra; Mello, Fernanda Carvalho de Queiroz; Malaquias, Thiago da Silva Santos; Croda, Julio; Pinhata, Juliana Maira Watanabe; Oliveira, Rosângela Siqueira de; Chimara, Erica; Rossetti, Maria Lúcia; Halon, Maria Laura; Lourenço, Maria Cristina; Medeiros, Reginalda Ferreira de Melo; Montes, Fátima Cristina Onofre Fandinho; Machado, Diana; Viveiros, Miguel; Kritski, Afrânio Lineu
    (1) Background: The Commercial Kit SIRE Nitratase® PlastLabor, is a drug susceptibility test kit used to detect Mycobacterium tuberculosis resistance to first-line TB treatment drugs. The present study aimed at evaluating its performance in a multicenter study. (2) Methods: To determine its accuracy, the proportion methods in Lowenstein Jensen medium or the BACTECTMMGITTM960 system was used as a gold standard. (3) Results: The study revealed that the respective accuracies of the kit with 190 M. tuberculosis clinical isolates, using the proportion methods in Lowenstein Jensen medium or BACTECTMMGITTM960 system as a gold standard, were 93.9% and 94.6%, 96.9% and 94.6%, 98.0% and 97.8%, and 98.0% and 98.9%, for streptomycin, isoniazid, rifampicin, and ethambutol, respectively. (4) Conclusion: Thus, the kit can rapidly screen resistance to streptomycin, isoniazid, rifampicin, and ethambutol. Additionally, it does not require sophisticated equipment; hence, it can be easily used in the laboratories of low and middle income countries.
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    Factors associated with tuberculosis and multidrug-resistant tuberculosis in patients treated at a tertiary referral hospital in the state of Minas Gerais, Brazil.
    (2020) Soares, Valéria Martins; Almeida, Isabela Neves de; Figueredo, Lida Jouca de Assis; Haddad, João Paulo Amaral; Oliveira, Camila Stefanie Fonseca de; Carvalho, Wânia da Silva; Miranda, Silvana Spíndola de
    Objective: To evaluate the risk factors for the development of tuberculosis and multidrugresistant tuberculosis (MDR-TB) in patients treated at a tertiary referral hospital. Methods: This was a cross-sectional study based on data obtained from patients treated at the Júlia Kubitschek Hospital, located in the city of Belo Horizonte, Brazil, between October of 2012 and October of 2014. We evaluated sociodemographic, behavioral, clinical, and radiological variables. The outcome considered to identify associations between tuberculosis and the explanatory variables was the treatment prescribed. To evaluate the associations between MDR-TB and the same explanatory variables, the change in MDR-TB treatment was considered. Results: The factors associated with tuberculosis were alcoholism, comorbidities, pulmonary cavitations, and a radiological pattern suggestive of tuberculosis. Cavitation and previous treatment for tuberculosis were associated with MDR-TB. Conclusions: Despite the significant progress made in the fight against tuberculosis, there is a need for coordinated actions that include social protection measures and patient support.
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    Genotype®MTBDRplus and Xpert®MTB/RIF in the diagnosis of tuberculosis and resistant tuberculosis : cost analysis in a tertiary referral hospital.
    (2020) Soares, Valéria Martins; Almeida, Isabela Neves de; Vater, Maria Cláudia; Alves, Suely; Figueredo, Lida Jouca de Assis; Scherer, Luciene; Kritski, Afranio Lineu; Carvalho, Wânia da Silva; Miranda, Silvana Spindola de
    Introduction: The present study sought to assess the mean and activity based cost (ABC) of the laboratory diagnosis for tuberculosis through the application of conventional and molecular techniques—Xpert®MTB/RIF and Genotype®MTBDRplus—in a tertiary referral hospital in Brazil. Methods: The mean cost and ABC formed the basis for the cost analysis of the TB laboratory diagnosis. Results: The mean cost and ABC were US$ 4.00 and US$ 3.24, respectively, for a bacilloscopy; US$ 6.73 and US$ 5.27 for a Lowenstein-Jensen (LJ) culture; US$ 105.42 and US$ 76.56 for a drug sensitivity test (DST)–proportions method (PM) in LJ; US$ 148.45 and US$ 136.80 for a DST–BACTECTM MGITTM 960 system; US$ 11.53 and US$ 9.89 for an Xpert®MTB/RIF; and US$ 84.21 and US$ 48.38 for a Genotype®MTBDRplus. Conclusions: The mean cost and ABC proved to be good decision-making parameters in the diagnosis of TB and MDR-TB. The effective implementation of algorithms will depend on the conditions at each location.
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    The activity-based cost of drug-susceptibility test of Mycobacterium tuberculosis through Kit SIRE Nitratase® plastlabor.
    (2020) Almeida, Isabela Neves de; Silva, Suely Conceição Alves da; Oliveira Junior, Haliton Alves de; Figueredo, Lida Jouca de Assis; Soares, Valéria Martins; Carvalho, Wânia da Silva; Kritski, Afrânio; Fiori, Maria Cláudia da Silva Vater da Costa; Miranda, Silvana Spíndola de
    Background: Drug‐resistant tuberculosis (TB) is an ongoing health threat, and the greatest challenge to adequate control of TB in many countries lies in the lack of proper laboratory drug‐susceptibility test. The aim of this study was to evaluate the activity‐based costs (ABC) of Kit SIRE Nitratase® (Kit SIRE) and compare its values with the conventional drug‐susceptibility test. Methods: The ABC was calculated for three different approaches: Kit SIRE (clinical samples and cultures), proportion methods in Lowenstein Jensen (PM‐LJ), and the BactecTM MGITTM 960 system based on Mycobacterial Research Laboratory’s routine. Results: The ABC of Kit SIRE from cultures was US$ 148.54, while from clinical samples was US$ 136.12. In the case of conventional tests, the ABC of BactecTM MGITTM 960 was US$ 227.63 and of the PM‐LJ was US$ 132.64. The Kit SIRE has a lower ABC when clinical samples are used instead of cultures. Compared to conventional tests, the ABC is similar to the PM‐LJ and lower the BactecTM MGITTM 960. Conclusion: The Kit SIRE should be used as a screening method in clinical specimens and in culture for laboratories that do not have BactecTM MGITTM 960. Therefore, it can be incorporated into the routine of laboratories in countries with low resources and a high burden of TB and drug‐resistant TB.