Panorama da tuberculose resistente no Brasil: revisão integrativa das evidências epidemiológicas, clínicas, diagnósticas e moleculares (2019–2025)
DOI:
https://doi.org/10.55892/jrg.v8i19.2789Palabras clave:
Brasil, Epidemiologia, Tuberculose multirresistente, Vigilância molecularResumen
A tuberculose resistente representa um dos principais desafios atuais para o controle da doença no Brasil, marcada pela persistência da transmissão comunitária, pela heterogeneidade regional e pela circulação crescente de perfis MDR, pre-XDR e XDR. Esta revisão integrativa analisou 22 estudos originais publicados entre 2019 e 2025 que investigaram aspectos epidemiológicos, clínicos, diagnósticos e moleculares da tuberculose resistente no país. Os resultados indicam que a resistência primária tem aumentado, sobretudo em centros urbanos, sugerindo transmissão sustentada de cepas resistentes. A caracterização molecular confirmou a predominância de mutações clássicas em rpoB, katG, inhA e gyrA/gyrB, além de perfis emergentes associados a resistência de segunda linha. Apesar da ampliação dos testes moleculares rápidos, limitações de cobertura, sensibilidade em cenários específicos e infraestrutura desigual comprometem o diagnóstico precoce. A adoção de regimes totalmente orais, especialmente aqueles compostos por bedaquilina e linezolida, trouxe avanços terapêuticos relevantes, embora toxicidade e risco de resistência emergente reforcem a necessidade de vigilância genômica. Barreiras socioeconômicas, custos altos e fragilidades na organização do cuidado continuam influenciando os desfechos. Conclui-se que o enfrentamento da DR-TB no Brasil exige integração entre inovação diagnóstica, terapêutica moderna, vigilância molecular estruturada e políticas públicas que reduzam desigualdades.
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