title: Multidrug-resistant tuberculosis in the Amazonas State, Brazil, 2000-2011.
abstract: METHODS
  Amazonas is facing increasing challenges in tuberculosis (TB) control, with nearly 3000 cases per year, and multidrug-resistant TB (MDR-TB) may jeopardise the TB control programme.
  
  
  OBJECTIVE
  To assess the number of MDR-TB cases in the Amazonas and to improve estimates of the burden of TB.
  
  
  METHODS
  The Brazilian National Mandatory Disease Reporting System (SINAN) and the Brazilian Epidemiological Surveillance System of Multidrug Resistance (TBMR) were searched for MDR-TB cases in the State of Amazonas from 2000 to 2011.
  
  
  RESULTS
  Eighty-one MDR-TB cases were notified. The rates of primary MDR-TB, initial MDR-TB during the first treatment regimen and acquired MDR-TB were respectively 3.8%, 13.7% and 82.7%; 26.9% of previously treated patients had ⩾ 4 treatment cycles. The MDR-TB cases reported 263 contacts, only 35.0% of whom were examined. The cure and death rates among the 81 patients with MDR-TB were respectively 45.7% and 25.9%.
  
  
  CONCLUSIONS
  The number of MDR-TB cases seems incompatible with the high TB prevalence in the Amazonas. Most patients were unaware of contact with TB patients. TB is endemic in the Amazonas. This highlights the need for improving resistance investigation among all TB cases.
authors: Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Vigilância em Saúde do Amazonas, Manaus, Amazonas, Brazil; Secretaria Municipal de Saúde de Manaus, Manaus, Amazonas, Brazil.
authors: M da S
authors: Mda S
authors: Garrido
authors: Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Patologia e Saúde Pública, Universidade Federal de Goiás, Goiânia, Goiás, Brazil.
authors: S
authors: S
authors: Bührer-Sékula
authors: Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil.
authors: A B
authors: AB
authors: Souza
authors: Programa Nacional de Tuberculose, Ministério da Saúde, Brasília, Brazil.
authors: G P
authors: GP
authors: de Oliveira
authors: Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil, Centro de Referência para Tuberculose Cardoso Fontes, Manaus, Amazonas, Brazil.
authors: I A
authors: IA
authors: Antunes
authors: Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Centro de Referência para Tuberculose Cardoso Fontes, Manaus, Amazonas, Brazil.
authors: J M
authors: JM
authors: Mendes
authors: Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
authors: V
authors: V
authors: Saraceni
authors: Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Manaus, Amazonas, Brazil.
authors: F E
authors: FE
authors: Martinez-Espinosa
authors: Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Universidade Nilton Lins, Manaus, Amazonas, Brazil; Programa de Pós-graduação em Imunologia Básica e Aplicada, Universidade Federal de Amazonas, Manaus, Amazonas, Brazil.
authors: R
authors: R
authors: Ramasawmy
mesh_terms: D000328:Adult; D017677:Age Distribution; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D003140:Communicable Disease Control / Q000458:organization & administration*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D020380:Needs Assessment; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*
chemical_list: D000995:Antitubercular Agents