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Karataş M, Dirie AMH, Çolakoğlu S, Hussein AO, Ali AN. Tuberculosis Treatment Outcomes and Associated Factors in Benadir Somalia. A Multicenter Cohort Study. Int J Gen Med 2024; 17:2711-2718. [PMID: 38895047 PMCID: PMC11184220 DOI: 10.2147/ijgm.s463237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024] Open
Abstract
Background In low-resource countries like Somalia, tuberculosis (TB) is still a serious global health concern. Understanding the treatment outcomes of TB patients in specific regions is crucial for developing effective strategies to combat the disease. This study aimed to assess the treatment outcomes of TB patients in Benadir, Somalia. Methods A retrospective cohort study was conducted using data from TB treatment centers in Benadir, Somalia. The study included all TB patients who initiated treatment between July 1, 2019 and June 30, 2020. Treatment outcomes, including treatment success, treatment failure, lost, death, and transfer out, were analyzed. Factors associated with treatment outcomes were also examined using chi-square test. Results The study comprised 3165 TB patients in total. The mean age of the observations was 29.9 years, with males making up the majority (64.58%). The overall success rate of TB treatment was 80.6%, with 5.3% lost, 4.6% died, 0.5% failed, 4.6% transferred out, and 4.4% not evaluated. Factors associated with unfavorable treatment outcomes included older age and HIV co-infection. Conclusion The treatment success rate for TB patients in Benadir, Somalia, is below the global target of 90%. Enhancing access to quality TB diagnostic and treatment services, as well as addressing social and economic barriers to treatment adherence, are essential for improving TB control in Benadir, Somalia.
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Affiliation(s)
- Mevlüt Karataş
- Pulmonology Department, Somalia Mogadishu Türkiye Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Benadir, Somalia
| | - Abdirahman Mohamed Hassan Dirie
- Pulmonology Department, Somalia Mogadishu Türkiye Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Benadir, Somalia
| | - Sedat Çolakoğlu
- Pulmonology Department, Somalia Mogadishu Türkiye Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Benadir, Somalia
| | - Abdirahman Osman Hussein
- Pulmonology Department, Somalia Mogadishu Türkiye Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Benadir, Somalia
| | - Amal Nor Ali
- Pulmonology Department, Somalia Mogadishu Türkiye Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Benadir, Somalia
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Birhanu MY, Bekele GM, Jemberie SS. Molecular detection of rifampicin-resistant Mycobacterium tuberculosis by polymerase chain reaction in Ethiopia: a systematic review and meta-analysis. Front Med (Lausanne) 2024; 11:1319845. [PMID: 38912342 PMCID: PMC11190194 DOI: 10.3389/fmed.2024.1319845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/11/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Tuberculosis is a contagious bacterial disease caused by Mycobacterium tuberculosis. The emergence and spread of drug-resistant strains of M. tuberculosis in both developing and developed countries has made diagnosis, treatment, and control of tuberculosis more difficult. The PCR assay, which is a fast and sensitive technique and an alternative method for detecting multidrug-resistant tuberculosis, is used to determine rifampicin (RIF) resistance. There is no single figure in Ethiopia that represents rifampicin-resistant tuberculosis and that is why this study was conducted to overcome the inconsistency of the results of the previous studies. Methods Studies were researched from five major electronic databases. Studies which were cross-sectional in design, published, and written in English were included. The data were extracted using Microsoft Excel, and the data were managed and analyzed using Stata™ Version 17.0 statistical software. The Forest plot was used to check the presence of heterogeneity. The publication bias, meta-regression, and subgroup analysis were used to find out the source of heterogeneity. A random effect analysis model was used to pool the prevalence of RR TB from primary studies, and associated factors of RR among TB patients were identified using Meta regression. The presence of association was reported using OR with 95% CI. Results The overall pooled prevalence of tuberculosis was 14.9% (95% CI: 13.34, 16.46), of these approximately 7.48% (95% CI: 6.30, 8.66) showed rifampicin-resistant tuberculosis in Ethiopia. Among the computed variables, 2.05% living with HIV1.39 (95%CI: 1.13, 1.72) and having a history of TB treatment (95%CI: 1.34, 3.15) were identified as significant factors associated with RR TB in Ethiopia. Conclusion Drug-resistant TB is one of the prevalent emerging infectious diseases among TB patients, which affects approximately one out of every thirteen TB patients. Having TB-HIV coinfection and a history of prior TB treatment were identified as significant factors associated with RR TB. To prevent and control RR TB, patients should complete their follow-up course; the health professionals should educate the actions taken by the patients when they experience drug toxicity and side effects; and the Minister of Health should initiate telemedicine and recruit tracers to overcome TB patients' default and have good drug adherence and retention after initiation of the treatment.
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Affiliation(s)
- Molla Yigzaw Birhanu
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Getamesay Molla Bekele
- Department of Gynecology and Obstetrics, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Selamawit Shita Jemberie
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Aispuro Pérez A, Osuna-Martínez U, Espinoza-Gallardo JA, Dorantes-Álvarez LA, Inzunza-Leyva GK, Dorantes-Bernal KE, Quiñonez-Bastidas GN. Prevalence of Drug-Resistant Tuberculosis in HIV-Positive and Diabetic Patients in Sinaloa, Mexico: A Retrospective Cross-Sectional Study. Trop Med Infect Dis 2024; 9:89. [PMID: 38668550 PMCID: PMC11054973 DOI: 10.3390/tropicalmed9040089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/11/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024] Open
Abstract
Tuberculosis (TB) is a disease caused by the bacillus Mycobacterium tuberculosis (MTB). Human immunodeficiency virus (HIV) infection and type 2 diabetes mellitus (T2DM) are among the main risk factors for the development of TB and increase the risk of drug-resistant TB developing (DR-TB). The aim of this study was to estimate the prevalence of DR-TB in patients with HIV or T2DM in Sinaloa, Mexico. This was an observational and cross-sectional study. The analysis was conducted using the clinical data of patients registered on the National Epidemiological Surveillance System for TB (SINAVE/PUI-TB) platform with a presumed diagnosis of TB during 2019 to 2021 in Sinaloa, Mexico. The prevalence of DR-TB was estimated in HIV and T2DM patients, as well as the odds ratios for their sociodemographic variables, using the Chi-square test. There were 2, 4, and 4 TB-HIV cases and 2, 6, and 9 TB-T2DM cases during 2019, 2020, and 2021, respectively, whereas there were 2 and 1 DRTB-HIV and DRTB-T2DM cases, respectively. The results indicated that the WHO guidelines for DR-TB were not properly applied to this high-risk population. Hence, the appropriate application of guidelines for TB and DR-TB detection in these patients needs to be immediately implemented by the State health system.
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Affiliation(s)
- Analy Aispuro Pérez
- Facultad de Ciencias Químico-Biológicas, Universidad Autónoma de Sinaloa, Ciudad Universitaria, Culiacan 80013, Sinaloa, Mexico; (A.A.P.); (U.O.-M.)
| | - Ulises Osuna-Martínez
- Facultad de Ciencias Químico-Biológicas, Universidad Autónoma de Sinaloa, Ciudad Universitaria, Culiacan 80013, Sinaloa, Mexico; (A.A.P.); (U.O.-M.)
| | - Jose Angel Espinoza-Gallardo
- Coordinación Estatal de Tuberculosis, Servicios de Salud de Sinaloa, Secretaria de Salud Blvd, Alfonso Zaragoza Maytorena No. 2204, Fraccionamiento Bonanzas, Culiacan 80020, Sinaloa, Mexico (L.A.D.-Á.); (K.E.D.-B.)
| | - Luis Alfredo Dorantes-Álvarez
- Coordinación Estatal de Tuberculosis, Servicios de Salud de Sinaloa, Secretaria de Salud Blvd, Alfonso Zaragoza Maytorena No. 2204, Fraccionamiento Bonanzas, Culiacan 80020, Sinaloa, Mexico (L.A.D.-Á.); (K.E.D.-B.)
| | - Gerardo Kenny Inzunza-Leyva
- Coordinación Estatal de Tuberculosis, Servicios de Salud de Sinaloa, Secretaria de Salud Blvd, Alfonso Zaragoza Maytorena No. 2204, Fraccionamiento Bonanzas, Culiacan 80020, Sinaloa, Mexico (L.A.D.-Á.); (K.E.D.-B.)
| | - Kimberly Estefania Dorantes-Bernal
- Coordinación Estatal de Tuberculosis, Servicios de Salud de Sinaloa, Secretaria de Salud Blvd, Alfonso Zaragoza Maytorena No. 2204, Fraccionamiento Bonanzas, Culiacan 80020, Sinaloa, Mexico (L.A.D.-Á.); (K.E.D.-B.)
| | - Geovanna Nallely Quiñonez-Bastidas
- Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Eustaquio Buelna 91, Burocrata, Culiacan 80030, Sinaloa, Mexico
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Amin W, Gadallah M, Salah A, Rady M. Prevalence of Rifampicin resistance tuberculosis among presumptive tuberculosis patients in Egypt-2021: a national health facility-based survey. BMC Infect Dis 2024; 24:210. [PMID: 38360617 PMCID: PMC10870666 DOI: 10.1186/s12879-023-08807-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 11/08/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND The magnitude of MDR-TB cases was noticeable in Egypt. However, the last national survey was 11-years ago. The current survey was conducted to determine the prevalence of rifampicin resistance among sputum smear-positive pulmonary tuberculosis patients in Egypt. METHODS A national health facility-based cross-sectional study was conducted in 14 randomly selected governorates in Egypt between August 2020 and September 2021. All presumptive TB cases, either new or previously treated according to WHO definitions, with no gender, age, or nationality limitations, and provided informed consent were included in the study. Each patient completed a case report form (CRF). The CRF included socio-demographic and clinical data. Sputum samples were collected according to standard techniques and cultured on Lowenstein-Jensen (L-J) medium. Gene X-pert test was carried out first on the samples for simultaneous identification of MTB and rifampicin resistance. The prevalence of RR was calculated using crude, cluster, and weighted methods. Factors associated with RR were analyzed by bivariate and multivariate techniques. RESULTS Among the total 849 presumptive TB patients enrolled in the study, 710 (83.6%) patients were subjected to Gene X-pert testing (MTB/RIF). The crude prevalence of RR was 3.32% (95% CI: 1.89-4.76%) among the new cases and 9.46% (95% CI: 2.63-16.29%) among the retreated cases with an overall estimate of 3.99%; (95% CI: 2.51-5.47%). By cluster analysis the overall prevalence of RR was 5.01% (95% CI: 2.90-7.13). Factors associated with the prevalence of RR were co-morbidity with bronchial asthma, drug abuse and history of contact with a family member with TB. CONCLUSION The prevalence of RR among either new or retreated cases TB patients was lower than the previous Egyptian rates in 2010-2012. The strongest predictor associated with RR was comorbidity with bronchial asthma.
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Affiliation(s)
- Wagdy Amin
- Chest Diseases Department, Ministry of Health and Population, Cairo, Egypt
| | - Mohsen Gadallah
- Community, Environmental and Occupational medicine department, Faculty of Medicine-Ain, Shams University, Cairo, Egypt
| | - Amal Salah
- National TB Control Program (NTP), Cairo, Egypt
| | - Mervat Rady
- Community, Environmental and Occupational medicine department, Faculty of Medicine-Ain, Shams University, Cairo, Egypt.
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Dirie AMH, Çolakoğlu S, Abdulle OM, Abdi BM, Osman MA, Shire AM, Hussein AM. Prevalence of Multidrug-Resistant TB Among Smear-Positive Pulmonary TB Patients in Banadir, Somalia: A Multicenter Study. Infect Drug Resist 2022; 15:7241-7248. [DOI: 10.2147/idr.s386497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
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Prevalence, associated factors and Rifampicin Resistance pattern of Pulmonary Tuberculosis among HIV-positive patients attending Antiretroviral Treatment Clinic at East Gojjam Zone, Ethiopia: An Institution-based Cross-Sectional study. J Clin Tuberc Other Mycobact Dis 2022; 29:100336. [DOI: 10.1016/j.jctube.2022.100336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pan Y, Yu Y, Lu J, Yi Y, Dou X, Zhou L. Drug Resistance Patterns and Trends in Patients with Suspected Drug-Resistant Tuberculosis in Dalian, China: A Retrospective Study. Infect Drug Resist 2022; 15:4137-4147. [PMID: 35937782 PMCID: PMC9348136 DOI: 10.2147/idr.s373125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/13/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose The emergence of drug-resistant tuberculosis (DR-TB) represents a threat to the control of tuberculosis. This study aimed to estimate the patterns and trends of DR-TB in patients with suspected DR-TB. In addition, risk factors for multidrug-resistant tuberculosis (MDR-TB) were identified among suspected DR-TB patients in Dalian, China. Patients and Methods A total of 5661 patients with suspected DR-TB from Jan 1, 2013 to Dec 31, 2020 were included in the final analysis. The resistance pattern of all resistant strains was determined by drug susceptibility testing (DST) using the conventional Lowenstein-Jensen Proportion Method (LJ). DR-TB trends were estimated from 2013 to 2020. During the research period, the chi-square test was employed to analyze the significance of linear drug-resistance trends across time. Bivariate and multivariate logistic regression were performed to assess factors associated with MDR-TB. Results From 2013 to 2020, the resistance rates of rifampicin (RFP) and isoniazid (INH) decreased significantly, whereas the resistance rates of ethambutol (EMB) and streptomycin (SM) increased in patients with suspected DR-TB. From 2013 to 2020, the prevalence of DR-TB decreased in all patients from 34.71% to 28.01% with an average annual decrease of 3.02%. Among new cases, from 2013 to 2020, the prevalence of DR-TB (from 26.67% to 24.75%), RFP-resistant TB (RR-TB) (from 15.09% to 3.00%) and MDR-TB (from 6.08% to 2.62%) showed a significant downward trend. Among patients with a previous treatment history, DR-TB (from 54.70% to 37.50%), RR-TB (from 44.16% to 11.49%) and MDR-TB (from 26.90% to 10.34%) showed a significant downward trend from 2013 to 2020. Males (AOR 1.28, 95% CI 1.035–1.585), patients 45 to 64 years of age (AOR 1.75, 95% CI 1.342–2.284), patients 65 years and older (AOR 1.65, 95% CI 1.293–2.104), rural residents (AOR 1.24, 95% CI 1.014–1.519) and a previous treatment history (AOR 3.94, 95% CI 3.275–4.741) were risk factors for MDR-TB. Conclusion The prevalence of DR-TB, RR-TB and MDR-TB was significantly reduced from 2013 to 2020. Considerable progress has been made in the prevention and treatment of DR-TB during this period. However, the increasing rate of drug resistance in EMB and SM should be taken seriously. Suspected DR-TB patients who are male, older than 45 years of age, live in rural areas, and have a history of TB treatment should be given priority by health care providers.
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Affiliation(s)
- Yuanping Pan
- School of Public Health, Dalian Medical University, Dalian, 116000, People’s Republic of China
| | - Yingying Yu
- School of Public Health, Dalian Medical University, Dalian, 116000, People’s Republic of China
| | - Jiachen Lu
- School of Public Health, Dalian Medical University, Dalian, 116000, People’s Republic of China
| | - Yaohui Yi
- School of Public Health, Dalian Medical University, Dalian, 116000, People’s Republic of China
| | - Xiaofeng Dou
- School of Public Health, Dalian Medical University, Dalian, 116000, People’s Republic of China
| | - Ling Zhou
- School of Public Health, Dalian Medical University, Dalian, 116000, People’s Republic of China
- Correspondence: Ling Zhou, School of Public Health, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian, Liaoning Province, People’s Republic of China, Tel +86 411 8611 0368, Email
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Yang F, Yu H, Kantipudi K, Karki M, Kassim YM, Rosenthal A, Hurt DE, Yaniv Z, Jaeger S. Differentiating between drug-sensitive and drug-resistant tuberculosis with machine learning for clinical and radiological features. Quant Imaging Med Surg 2022; 12:675-687. [PMID: 34993110 DOI: 10.21037/qims-21-290] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/23/2021] [Indexed: 12/12/2022]
Abstract
Background Tuberculosis (TB) drug resistance is a worldwide public health problem that threatens progress made in TB care and control. Early detection of drug resistance is important for disease control, with discrimination between drug-resistant TB (DR-TB) and drug-sensitive TB (DS-TB) still being an open problem. The objective of this work is to investigate the relevance of readily available clinical data and data derived from chest X-rays (CXRs) in DR-TB prediction and to investigate the possibility of applying machine learning techniques to selected clinical and radiological features for discrimination between DR-TB and DS-TB. We hypothesize that the number of sextants affected by abnormalities such as nodule, cavity, collapse and infiltrate may serve as a radiological feature for DR-TB identification, and that both clinical and radiological features are important factors for machine classification of DR-TB and DS-TB. Methods We use data from the NIAID TB Portals program (https://tbportals.niaid.nih.gov), 1,455 DR-TB cases and 782 DS-TB cases from 11 countries. We first select three clinical features and 26 radiological features from the dataset. Then, we perform Pearson's chi-squared test to analyze the significance of the selected clinical and radiological features. Finally, we train machine classifiers based on different features and evaluate their ability to differentiate between DR-TB and DS-TB. Results Pearson's chi-squared test shows that two clinical features and 23 radiological features are statistically significant regarding DR-TB vs. DS-TB. A ten-fold cross-validation using a support vector machine shows that automatic discrimination between DR-TB and DS-TB achieves an average accuracy of 72.34% and an average AUC value of 78.42%, when combing all 25 statistically significant features. Conclusions Our study suggests that the number of affected lung sextants can be used for predicting DR-TB, and that automatic discrimination between DR-TB and DS-TB is possible, with a combination of clinical features and radiological features providing the best performance.
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Affiliation(s)
- Feng Yang
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Hang Yu
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Karthik Kantipudi
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Manohar Karki
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Yasmin M Kassim
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Alex Rosenthal
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Darrell E Hurt
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Ziv Yaniv
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Stefan Jaeger
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
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Madukaji L, Okohu I, Usman S, Oyedum U, Enagi A, Usman A, Adedeji AS, Owolagba F, Ofuche E, Samuels JO, Jolayemi T, Okonkwo P. Early detection of Pre-XDR TB with line probe assay in a high TB burden country. Afr Health Sci 2021; 21:968-974. [PMID: 35222556 PMCID: PMC8843309 DOI: 10.4314/ahs.v21i3.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Worldwide, tuberculosis (TB) is one of the top 10 causes of death. Drug resistant tuberculosis has lately become a major public health problem that threatens progress made in Tuberculosis (TB) care and control worldwide. The aim of this study was to determine the prevalence of Pre-extensive drug resistant TB among MDR TB in North Central of Nigeria. Methods This study was conducted from October, 2018 to August, 2019 with 150 samples. In Nigeria, guidelines for DR-TB as recommended by WHO is followed. All the samples from the patients who gave their consent were transported to a zonal reference TB laboratory (ZRL). Results Mean age was 38.6 ± 13.4 years with peak age at 35–44. Out of these 103 samples processed with LPA, 101(98%) were rifampicin resistant and 2 were rifampicin sensitive, 99(96%) were INH resistant and 4 (4%) were INH sensitive, 5(5%) were fluoroquinolone resistant, 98(95%) were fluoroquinolone sensitive, 12 (12%) were Aminoglycoside + Capreomycin resistant, 91(83%) were Aminoglycoside + Capreomycin sensitive. Conclusion Multidrug resistant TB and its severe forms (Pre-extensive & extensively drug resistant TB) can be detected early with rapid tool- Line Probe Assay rapid and prevented timely by early initiation on treatment.
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Affiliation(s)
| | | | | | - Uche Oyedum
- Federal University of Technology Minna, Nigeria
| | | | | | - AS Adedeji
- Federal University of Technology Minna, Nigeria
| | | | - Eke Ofuche
- APIN Public Health Initiatives Abuja, Nigeria
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Wasihun AG, Hailu GG, Dejene TA. Prevalence of Mycobacterium tuberculosis (Rifampicin-Resistant MTB) and Associated Risk Actors Among Pulmonary Presumptive TB Patients in Eastern Amhara, Ethiopia: 2015-2019. Infect Dis Ther 2021; 10:1299-1308. [PMID: 33950463 PMCID: PMC8322199 DOI: 10.1007/s40121-020-00368-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/24/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Tuberculosis (TB) is a major health problem, mainly in resource-limited settings. The aim of this study was to determine the prevalence of TB and rifampicin-resistant Mycobacterium tuberculosis (RR-MTB) among presumptive tuberculosis patients using Xpert MTB/RIF assay in Eastern Amhara, Ethiopia. METHODS A retrospective cross-sectional study was conducted among presumptive TB patients from three governmental hospitals in Amhara Regional State. Records of sputum sample results using Xpert MTB/RIF assay from January 2015 to December 2019 were investigated from registration books and analyzed using SPSS v.21. RESULTS Of the total of 26,656 (24,116 adults and 2540 children) TB presumptive patients included in the study, more than half, 14,624 (54.9%), were males and the median age was 36.87 (interquartile: 25.46-50.85 years). The majority of participants were new cases, 20,273 (76.1%), and with unknown HIV status, 18,981 (71.2%), respectively. MTB prevalence was 11% (95% CI: 9.34-12.08%) in all age groups, and 7.6% (95% CI 6.52-9.04%) among children. Of the MTB confirmed cases, prevalence of RR-MTB was 245 (8.3%) in adults and 14 (7.2%) in children. MTB infection was higher in the age groups of 18-35 years [adjusted odds ratio (AOR) = 2.17; 95% CI: 1.86-2.54, p < 0.001], 36-53 years (AOR = 1.31; 95% CI 1.11-1.54, p < 0.001), those who were relapse cases (AOR = 1.97; 95% CI 1.69-2.27, p < 0.0010), and failure cases (AOR = 4.67; 95% CI 3.36-6.50, p < 0.001). However, the age groups of 54-71 years (AOR = 0.79; 95% CI 0.65-0.95, p = 0.01) and over 71 years (AOR = 0.48; 95% CI 0.35-0.68, p < 0.001) were associated with lower MTB infection. Resistance to rifampicin was higher in the relapsed (AOR = 2.10; 95% CI 1.40-3.03, p < 0.001) and failure cases (AOR = 3.50; 95% CI 1.9-6.61, p < 001). CONCLUSION Prevalence of MTB and RR-MTB low. TB infection was higher in adult age groups and those who had previous TB treatment history. Similarly, resistance to rifampicin was higher among the relapsed and failure patients. Appropriate measurements in monitoring of TB treatment could reduce TB and RR-MTB in the study area.
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Affiliation(s)
- Araya Gebreyesus Wasihun
- Department of Medical Microbiology and Immunology, School of Medicine, Mekelle University, Mekelle, Ethiopia.
| | - Genet Gebrehiwet Hailu
- Department of Medical Microbiology and Immunology, School of Medicine, Mekelle University, Mekelle, Ethiopia
| | - Tsehaye Asmelash Dejene
- Department of Medical Microbiology and Immunology, School of Medicine, Mekelle University, Mekelle, Ethiopia.,Department of Medical Microbiology and Immunology, School of Medicine, Aksum University, Aksum, Ethiopia
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Yigzaw WB, Torrelles JB, Wang SH, Tessema B. Magnitude of Phenotypic and MTBDRplus Line Probe Assay First-Line Anti-Tuberculosis Drug Resistance Among Tuberculosis Patients; Northwest Ethiopia. Infect Drug Resist 2021; 14:497-505. [PMID: 33603414 PMCID: PMC7882791 DOI: 10.2147/idr.s292058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/28/2021] [Indexed: 12/03/2022] Open
Abstract
Background Mycobacterium tuberculosis (Mtb) drug resistance is a key challenge in ending TB. Objective The study aimed to determine anti-TB drug resistance and compare the discordance between phenotypic and genotypic drug-susceptibility testing (DST). Methods Prospective enrollment and sputum collection from patients suspected of active pulmonary TB from May 2018 to December 2019 at the University of Gondar Hospital. Phenotypic DST study for streptomycin, isoniazid, rifampin, and ethambutol was done by MGIT 360 SIRE Kit. Genotypic resistance for isoniazid and rifampin was performed by MTBDRplus v2 line probe assay (LPA) and compared to phenotypic drug resistance. Results A total of 376 patients, median age 32 years, and 53.7% male were enrolled. Mtb was isolated from 126 patients. 106/126 (84%) patients were newly diagnosed with TB and 20 patients with prior TB treatment. Seventy (66.0%) were susceptible to all anti‐TB drugs tested. Twenty-five (19.8%) of the isolates were resistant to isoniazid, 12 (9.5%) to rifampicin and six (5%) were multidrug resistant. Among previously treated TB patients, 4 (20.0%) and 5 (25.0%) were mono-resistant and poly-resistant, respectively. The sensitivity and specificity of LPA resistance for isoniazid were 94.4% and 100%, and for rifampin was 75.0% and 100%, respectively. Conclusion The frequency of mono- and poly-drug resistance among both newly diagnosed and previously treated TB patients was high to the rest of the nation. MTBDRplus showed excellent concordance for isoniazid and rifampin. We concluded that DST should be performed for all patients to improve management and decrease spread of drug-resistant Mtb strains in the community.
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Affiliation(s)
- Wubet Birhan Yigzaw
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Jordi B Torrelles
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Shu-Hua Wang
- Department of Internal Medicine, Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Belay Tessema
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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McQuaid CF, Horton KC, Dean AS, Knight GM, White RG. The risk of multidrug- or rifampicin-resistance in males versus females with tuberculosis. Eur Respir J 2020; 56:13993003.00626-2020. [PMID: 32430421 DOI: 10.1183/13993003.00626-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/07/2020] [Indexed: 01/10/2023]
Abstract
Males are at an increased risk of tuberculosis (TB) disease compared to females. Additionally, several risk factors for multidrug-resistant (MDR) or rifampicin-resistant (RR) TB disease are more common in males, hence male TB patients may have a higher relative risk of MDR/RR-TB than female TB patients.We used sex-disaggregated data of TB patients reported to the World Health Organization for 106 countries to calculate male-to-female (M:F) risk ratios of having MDR/RR-TB.There was no evidence of either sex being more at risk of MDR/RR-TB in 81% (86 out of 106) of countries, with an overall random-effects weighted M:F risk ratio of 1.04 (95% CI 0.97-1.11). In 12% (13 out of 106) of countries there was evidence that males were more at risk, while in 7% (seven out of 106), females were more at risk. The risk of having TB that was MDR/RR increased for males compared to females as MDR/RR-TB incidence increased, and was higher for males than females in the former Soviet Union, where the risk ratio was 1.16 (1.06-1.28). Conversely, the risk increased for females compared to males as gross domestic product purchase power parity increased, and was higher for females than males in countries where the majority of TB burden was found in the foreign-born population, where the risk ratio was 0.84 (0.75-0.94).In general, the risk of MDR/RR-TB, among those with TB, is the same for males as for females. However, males in higher MDR/RR-TB burden countries, particularly the former Soviet Union, face an increased risk that their infection is MDR/RR-TB, highlighting the need for a sex-differentiated approach to TB case-finding and care.
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Affiliation(s)
- C Finn McQuaid
- TB Modelling Group, TB Centre, AMR Centre and Centre for Mathematical Modelling of Infectious Diseases, Dept of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Katherine C Horton
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Dept of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna S Dean
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Gwenan M Knight
- TB Modelling Group, TB Centre, AMR Centre and Centre for Mathematical Modelling of Infectious Diseases, Dept of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard G White
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Dept of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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