title: The challenge of managing extensively drug-resistant tuberculosis at a referral hospital in the state of São Paulo, Brazil: a report of three cases.
abstract: Here, we report the cases of three patients diagnosed with extensively drug-resistant tuberculosis and admitted to a referral hospital in the state of São Paulo, Brazil, showing the clinical and radiological evolution, as well as laboratory test results, over a one-year period. Treatment was based on the World Health Organization guidelines, with the inclusion of a new proposal for the use of a combination of antituberculosis drugs (imipenem and linezolid). In the cases studied, we show the challenge of creating an acceptable, effective treatment regimen including drugs that are more toxic, are more expensive, and are administered for longer periods. We also show that treatment costs are significantly higher for such patients, which could have an impact on health care systems, even after hospital discharge. We highlight the fact that in extreme cases, such as those reported here, hospitalization at a referral center seems to be the most effective strategy for providing appropriate treatment and increasing the chance of cure. In conclusion, health professionals and governments must make every effort to prevent cases of multidrug-resistant and extensively drug-resistant tuberculosis.
authors.affiliation: Hospital Nestor Goulart Reis, Secretaria de Estado da Saúde do Estado de São Paulo, Américo Brasiliense, SP, Brasil.
authors.forename: Marcos Abdo
authors.initials: MA
authors.lastname: Arbex
authors.affiliation: Disciplina de Pneumologia e Tisiologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors.forename: Hélio Ribeiro de
authors.initials: HR
authors.lastname: Siqueira
authors.affiliation: WHO Collaborating Centre for TB and Lung Diseases, Istituto Scientifico, Fondazione Salvatore Maugeri, Tradate, Italia.
authors.forename: Lia
authors.initials: L
authors.lastname: D'Ambrosio
authors.affiliation: WHO Collaborating Centre for TB and Lung Diseases, Istituto Scientifico, Fondazione Salvatore Maugeri, Tradate, Italia.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Migliori
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001938:Brazil; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use*; D000069349:Linezolid / Q000627:therapeutic use*; D008297:Male
chemical_list: D000995:Antitubercular Agents; D015378:Imipenem; D000069349:Linezolid