Perfil clínico-epidemiológico e laboratorial dos pacientes com tuberculose em serviço de referência do sudeste do Brasil

Abstract

Introduction: tuberculosis (TB) was considered one of the thirteen leading causes of death worldwide in 2019. The determination of the clinical-epidemiological and laboratory profile of TB cases seen in referrals allows highlighting the social and clinical particularities of a given group of patients, which can be compared to the regional or national reality. Objective: to evaluate the clinical-epidemiological and laboratory profile of patients with TB in a Secondary Reference Outpatient Clinic of a High Complexity Hospital. Methods: this is an epidemiological clinical study with an observational design: a cohort of patients with TB treated at a Secondary Reference Clinic for TB at the Clinical Hospital of Federal University of Minas Gerais (CH/FUMG), in the period from January 2013 to August 2021. The patients were followed up after entering the outpatient clinic, at the end of the second month of treatment and at the end of treatment. Data were collected through interviews and/or consultation of medical records and secondary databases. Descriptive analyses were carried out. Chi-squared test with Bonferroni correction and Anova test with Tukey correction were used to compare the three TB clinical forms concerning socio-demographic variables. Results: the total number of patients analyzed was 227, distributed as follows: 91 (40.09%) were diagnosed with pulmonary TB; 115 (50.66%) with extrapulmonary TB; 21 (9.25%) with both forms. At the first medical consultation, the main symptoms of patients with pulmonary TB consisted of cough for more than two weeks (66/91 – 72.53%) and expectoration (48/91 – 52.75%). In extrapulmonary TB, the symptoms were related to the affected organ and the eye was the most affected site, in 59/115 (51.30%). In pulmonary and extrapulmonary TB, the main symptoms were anorexia in 10/21 (47.62%) and cough in 9/21 (42.86%). The most frequent comorbidity was Diabetes Mellitus (DM) in 39/227 (17.18%). The frequency of males was 115/227 (50.66%), alcoholism 106/208 (50.96%) and smoking 101/216 (46.76%). In cases with pulmonary involvement (n=112), the images were suggestive of active TB (67/80 – 83.75% of radiographs and 27/27 - 100% of chest CT scans). At the end of the second month of treatment, there was clinical, laboratory and radiological improvement and the most frequent Adverse Drug Reaction (ADR) was nausea/vomiting (42.65%), regardless of the clinical form of TB. At the end of follow-up, it was observed that Directly Observed Treatment (DOT) was performed in 15/197 (7.61%) and the most common outcome was cure, in 210/227 (92.51%) of patients. Conclusion: the majority of patients had extrapulmonary TB. At the end of the second month of treatment, the most common ADR was náusea/vomiting. The majority of patients had a “cure” outcome and did not perform DOT. TB treatment at this Reference Center is a model to be replicated in other TB treatment centers.