1
|
Xie L, Zhu XY, Xu L, Xu XX, Ruan ZF, Huang MX, Chen L, Jiang XW. Accurate and affordable detection of rifampicin and isoniazid resistance in Tuberculosis sputum specimens by multiplex PCR-multiple probes melting analysis. Infection 2024:10.1007/s15010-024-02295-w. [PMID: 38884858 DOI: 10.1007/s15010-024-02295-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/10/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Escalating cases of multidrug-resistant tuberculosis (MDR-TB) pose a major challenge to global TB control efforts, necessitating innovative diagnostics to empower decentralized detection of gene mutations associated with resistance to rifampicin (RIF) and isoniazid (INH) in Mycobacterium tuberculosis (M. tuberculosis) in resource-constrained settings. METHODS Combining multiplex fluorescent PCR and Multiple Probes Melting Analysis, we identified mutations in the rpoB, katG, ahpC and inhA genes from sputum specimens. We first constructed a reference plasmid library comprising 40 prevalent mutations in the target genes' resistance determining regions and promoters, serving as positive controls. Our assay utilizes a four-tube asymmetric PCR method with specifically designed molecular beacon probes, enabling simultaneous detection of all 40 mutations. We evaluated the assay's effectiveness using DNA isolated from 50 clinically confirmed M. tuberculosis sputum specimens, comparing our results with those obtained from Sanger sequencing and retrospective validation involving bacteriological culture and phenotypic drug susceptibility testing (pDST). We also included the commercial Xpert MTB/RIF assay for accuracy comparison. RESULTS Our data demonstrated remarkable sensitivity in detecting resistance to RIF and INH, achieving values of 93.33% and 95.24%, respectively, with a specificity of 100%. The concordance between our assay and pDST was 98.00%. Furthermore, the accuracy of our assay was comparable to both Sanger sequencing and the Xpert assay. Importantly, our assay boasts a 4.2-h turnaround time and costs only $10 per test, making it an optimal choice for peripheral healthcare settings. CONCLUSION These findings highlight our assay's potential as a promising tool for rapidly, accurately, and affordably detecting MDR-TB.
Collapse
Affiliation(s)
- Long Xie
- Clinical and Translational Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Xiao-Ya Zhu
- State Key Laboratory of Virology, School of Life Sciences, Wuhan University, Wuhan, China
| | - Li Xu
- Research Institute, DAAN Gene Co., Ltd., Guangzhou, China
- The Medicine and Biological Engineering Technology Research Centre of the Ministry of Health, Guangzhou, China
| | - Xiao-Xie Xu
- Research Institute, DAAN Gene Co., Ltd., Guangzhou, China
- The Medicine and Biological Engineering Technology Research Centre of the Ministry of Health, Guangzhou, China
| | - Ze-Fan Ruan
- Research Institute, DAAN Gene Co., Ltd., Guangzhou, China
- The Medicine and Biological Engineering Technology Research Centre of the Ministry of Health, Guangzhou, China
| | - Ming-Xiang Huang
- Fuzhou Pulmonary Hospital and Fujian Medical University Clinical Teaching Hospital, Fuzhou, China.
| | - Li Chen
- Chaoshan Hospital, The First Affiliated Hospital of Jinan University, Chaozhou, China.
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Xi-Wen Jiang
- Research Institute, DAAN Gene Co., Ltd., Guangzhou, China.
- The Medicine and Biological Engineering Technology Research Centre of the Ministry of Health, Guangzhou, China.
- School of Life Sciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangzhou, China.
| |
Collapse
|
2
|
Gupta RK, Anthwal D, Bhalla M, Tyagi JS, Choudhary S, Haldar S. Direct Detection of Fluoroquinolone Resistance in Sputum Samples from Tuberculosis Patients by High Resolution Melt Curve Analysis. Curr Microbiol 2023; 81:27. [PMID: 38041739 DOI: 10.1007/s00284-023-03519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/07/2023] [Indexed: 12/03/2023]
Abstract
Multidrug-resistant tuberculosis (MDR-TB) requires treatment with fluoroquinolone (FLQ) drugs, however, the excessive use of FLQ has led to the rise of extensively drug-resistant TB. In 2019, ~ 20% of total MDR-TB cases were estimated to be resistant to FLQ drugs. In the present study, we developed and evaluated the utility of high-resolution melt curve analysis (HRM) for the rapid detection of FLQ-resistant Mycobacterium tuberculosis for the first time directly from sputum samples. A reference plasmid library was generated for the most frequently observed mutations of gyrA gene and was used to discriminate between mutant and wild-type samples in the FLQ-HRM assay. The developed assay was evaluated on n = 25 MDR M. tuberculosis clinical isolates followed by validation on archived sputum DNA (n = 88) using DNA sequencing as a gold standard. The FLQ-HRM assay showed a 100% sensitivity [95% Confidence Interval (CI): 71.5 to 100] and specificity (95% CI: 39.7 to 100) in smear-positive category, and a sensitivity of 88.9% (95% CI: 77.3 to 95.8) with 84.2% (95% CI: 60.4 to 96.6) specificity in smear-negative category. The assay showed a high level of concordance of ~ 90% (κ = 0.74) with DNA sequencing, however, we were limited by the absence of phenotypic drug susceptibility testing data. In conclusion, HRM is a rapid, cost-effective (INR 150/USD 1.83) and closed-tube method for direct detection of FLQ resistance in sputum samples including direct smear-negative samples.
Collapse
Affiliation(s)
- Rakesh Kumar Gupta
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
- Department of Bioscience and Biotechnology, Banasthali Vidyapith, P.O. Banasthali Vidyapith, Rajasthan, 304022, India
| | - Divya Anthwal
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
- Department of Bioscience and Biotechnology, Banasthali Vidyapith, P.O. Banasthali Vidyapith, Rajasthan, 304022, India
| | - Manpreet Bhalla
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Mehrauli, New Delhi, India
| | - Jaya Sivaswami Tyagi
- Department of Biotechnology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sangeeta Choudhary
- Department of Bioscience and Biotechnology, Banasthali Vidyapith, P.O. Banasthali Vidyapith, Rajasthan, 304022, India
| | - Sagarika Haldar
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3Rd Milestone, Faridabad-Gurgaon Expressway, PO box #04, Faridabad, India.
| |
Collapse
|
3
|
Sharma K, Sharma M, Sharma A, Dhillon MS. Diagnosing osteo-articular tuberculosis and multidrug resistance using real-time polymerase chain reaction and high-resolution melt-curve analysis. J Orthop Res 2023; 41:891-896. [PMID: 35780389 DOI: 10.1002/jor.25410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/21/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023]
Abstract
The study evaluated real-time quantitative polymerase chain reaction (qPCR) and high-resolution melt-curve analysis (HRM) for simultaneous diagnosis of osteo-articular tuberculosis (OATB) and drug resistance. Two hundred and fifty synovial fluid and pus specimens (20 confirmed OATB by culture, 130 suspected OATB, and 100 controls) processed in the Department of Medical Microbiology, PGIMER were subjected to qPCR using rpoB, MPB64, and IS6110 genes. All OATB positive specimens were subjected to HRM for detecting resistance to rifampicin and isoniazid. qPCR detected 129/150 OATB cases with a sensitivity of 86% (95% for confirmed and 84.6% for suspected OATB cases) and specificity of 100%. rpoB and MPB64 genes had higher sensitivity than IS6110 (86% vs. 74.6%). HRM reported eight multidrug resistant (MDR), two mono-rifampicin, and five mono-isoniazid resistant cases, all were concordant with gene sequencing. qPCR followed by HRM analysis offer a simple, accurate, and rapid platform for simultaneous detection of OATB and MDR.
Collapse
Affiliation(s)
- Kusum Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Megha Sharma
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bilaspur, Himachal Pradesh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mandeep Singh Dhillon
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
4
|
Yang H, Li A, Dang L, Kang T, Ren F, Ma J, Zhou Y, Yang Y, Lei J, Zhang T. A rapid, accurate, and low-cost method for detecting Mycobacterium tuberculosis and its drug-resistant genes in pulmonary tuberculosis: Applications of MassARRAY DNA mass spectrometry. Front Microbiol 2023; 14:1093745. [PMID: 36910195 PMCID: PMC9996023 DOI: 10.3389/fmicb.2023.1093745] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Mycobacterium tuberculosis (MTB) identification and drug resistance diagnosis are very important for treatment of drug-resistant tuberculosis (DR-TB). Therefore, high throughput, accurate and low-cost molecular detection techniques are urgently needed. This study aimed to evaluate the clinical application value of MassARRAY in tuberculosis diagnosis and drug resistance screening. Methods The limit of detection (LOD) and clinical application value of MassARRAY were evaluated using reference strains and clinical isolates. MTB in bronchoalveolar lavage fluid (BALF) and sputum samples were detected using MassARRAY, quantitative real-time polymerase chain reaction (qPCR) and MGIT960 liquid culture (culture). Using culture as the standard, the efficacy of MassARRAY and qPCR for the detection of TB was analyzed. Mutation of drug resistance genes in MTB clinical isolates was tested using MassARRAY, high-resolution melting curve (HRM), and Sanger sequencing. Using sequencing as the standard, the efficacy of MassARRAY, and HRM for the detection of each drug resistance site of MTB was analyzed. Simultaneously, the mutation of drug resistance genes by the MassARRAY method was compared with the results of drug susceptibility testing (DST), and the genotype-phenotype relationship was analyzed. The ability of MassARRAY to discriminate mixed infections was detected using mixtures of standard strains (M. tuberculosis H37Rv) and drug-resistant clinical isolates and mixtures of wild-type and mutant plasmids. Results In MassARRAY, 20 related gene mutations could be detected by two PCR systems. All genes could be accurately detected when the bacterial load was 104 CFU/mL. When the load of wild-type and drug-resistant MTB mixture was 105 CFU/mL (respectively reached 104 CFU/mL), variants and wild-type genes could be detected simultaneously. The sensitivity of MassARRAY (96.9%) for identification was higher than that of qPCR (87.5%) (p < 0.001). The sensitivity and specificity of MassARRAY for all drug resistance gene mutations were 100.0%, with higher accuracy and consistency than HRM (sensitivity = 89.3% and specificity = 96.9%, p = 0.001). Analyzing the relationship between MassARRAY genotype and DST phenotype, the accuracy of katG_315, rpoB_531, rpsL_43, rpsL_88, and rrs_513 sites was 100.0%, and embB_306 and rpoB_526 were inconsistent with the DST results when the base changes were different. Discussion MassARRAY can obtain base mutation information and identify heteroresistance infections simultaneously when the mutant proportion was at least 5-25%. It has good application prospects in the diagnosis of DR-TB with high throughput, accurate and low-cost.
Collapse
Affiliation(s)
- Han Yang
- College of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Medical Transformation Centre, Xi'an Chest Hospital, Xi 'an Jiaotong University Health Science Center, Xi'an, China
| | - Aifang Li
- Department of Laboratory Medicine, Xi'an Chest Hospital, Xi 'an Jiaotong University Health Science Center, Xi'an, China
| | - Liyun Dang
- Department of Tuberculosis, Xi'an Chest Hospital, Xi 'an Jiaotong University Health Science Center, Xi'an, China
| | - Tao Kang
- Department of Reagent, Zhejiang Digena Diagnosis Technology CO., LTD, Zhejiang, China
| | - Fei Ren
- Department of Tuberculosis, Xi'an Chest Hospital, Xi 'an Jiaotong University Health Science Center, Xi'an, China
| | - Jinbao Ma
- Department of Tuberculosis, Xi'an Chest Hospital, Xi 'an Jiaotong University Health Science Center, Xi'an, China
| | - Yong Zhou
- Endoscopy Clinic Centre, Xi'an Chest Hospital, Xi 'an Jiaotong University Health Science Center, Xi'an, China
| | - Yuanli Yang
- Department of Tuberculosis, Xi'an Chest Hospital, Xi 'an Jiaotong University Health Science Center, Xi'an, China
| | - Jing Lei
- Department of Laboratory Medicine, Xi'an Chest Hospital, Xi 'an Jiaotong University Health Science Center, Xi'an, China
| | - Tao Zhang
- College of Pharmacy, Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
5
|
Singh P, Velez FJ. Real-Time PCR High-Resolution Melting Assays for the Detection of Foodborne Pathogens. Methods Mol Biol 2023; 2967:41-52. [PMID: 37608101 DOI: 10.1007/978-1-0716-3358-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Real-time PCR high-resolution melting assays are a method for the identification of single nucleotide polymorphisms (SNPs). The assay is performed by amplifying a short DNA fragment using a specific primer pair flanking a target SNP in the presence of a high-resolution melting dye. The HRM analysis of amplicons groups the samples based on the differences in the melting temperature and the shape of the melt curves, facilitating a convenient genotyping of samples. This chapter describes the steps and considerations of real-time PCR HRM assay standardization.
Collapse
Affiliation(s)
- Prashant Singh
- Department of Nutrition, and Integrative Physiology, Florida State University, Tallahassee, FL, USA.
| | - Frank J Velez
- Department of Nutrition, and Integrative Physiology, Florida State University, Tallahassee, FL, USA
| |
Collapse
|
6
|
Wang Z, Guo T, Jiang T, Zhao Z, Zu X, li L, Zhang Q, Hou Y, Song K, Xue Y. Regional distribution of Mycobacterium tuberculosis infection and resistance to rifampicin and isoniazid as determined by high-resolution melt analysis. BMC Infect Dis 2022; 22:812. [PMCID: PMC9620668 DOI: 10.1186/s12879-022-07792-7] [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: 06/27/2022] [Revised: 09/29/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Identifying the transmission mode and resistance mechanism of Mycobacterium tuberculosis (MTB) is key to prevent disease transmission. However, there is a lack of regional data. Therefore, the aim of this study was to identify risk factors associated with the transmission of MTB and regional patterns of resistance to isoniazid (INH) and rifampicin (RFP), as well as the prevalence of multidrug-resistant tuberculosis (MDR-TB). Methods High-resolution melt (HRM) analysis was conducted using sputum, alveolar lavage fluid, and pleural fluid samples collected from 17,515 patients with suspected or confirmed MTB infection in the downtown area and nine counties of Luoyang City from 2019 to 2021. Results Of the 17,515 patients, 82.6% resided in rural areas, and 96.0% appeared for an initial screening. The HRM positivity rate was 16.8%, with a higher rate in males than females (18.0% vs. 14.1%, p < 0.001). As expected, a positive sputum smear was correlated with a positive result for HRM analysis. By age, the highest rates of MTB infection occurred in males (22.9%) aged 26–30 years and females (28.1%) aged 21–25. The rates of resistance to RFP and INH and the incidence of MDR were higher in males than females (20.5% vs. 16.1%, p < 0.001, 15.9% vs. 12.0%, p < 0.001 and 12.9% vs. 10.2%, p < 0.001, respectively). The HRM positivity rate was much higher in previously treated patients than those newly diagnosed for MTB infection. Notably, males at the initial screening had significantly higher rates of HRM positive, INH resistance, RFP resistance, and MDR-TB than females (all, p < 0.05), but not those previously treated for MTB infection. The HRM positivity and drug resistance rates were much higher in the urban vs. rural population. By multivariate analyses, previous treatment, age < 51 years, residing in an urban area, and male sex were significantly and positively associated with drug resistance after adjusting for smear results and year of testing. Conclusion Males were at higher risks for MTB infection and drug resistance, while a younger age was associated with MTB infection, resistance to INH and RFP, and MDR-TB. Further comprehensive monitoring of resistance patterns is needed to control the spread of MTB infection and manage drug resistance locally.
Collapse
Affiliation(s)
- Zhenzhen Wang
- grid.453074.10000 0000 9797 0900The First Affiliated Hospital and Clinical Medical College, Henan University of Science and Technology, 471000 Luo Yang, China ,grid.453074.10000 0000 9797 0900School of Medical Technology and Engineering, Henan University of Science and Technology, Luo Yang, 471000 China
| | - Tengfei Guo
- grid.453074.10000 0000 9797 0900The First Affiliated Hospital and Clinical Medical College, Henan University of Science and Technology, 471000 Luo Yang, China
| | - Tao Jiang
- grid.453074.10000 0000 9797 0900The First Affiliated Hospital and Clinical Medical College, Henan University of Science and Technology, 471000 Luo Yang, China
| | - Zhanqin Zhao
- grid.453074.10000 0000 9797 0900Animal Science and Technology, Henan University of Science and Technology, Luo Yang, 471000 China
| | - Xiangyang Zu
- grid.453074.10000 0000 9797 0900School of Medical Technology and Engineering, Henan University of Science and Technology, Luo Yang, 471000 China
| | - Long li
- grid.453074.10000 0000 9797 0900The First Affiliated Hospital and Clinical Medical College, Henan University of Science and Technology, 471000 Luo Yang, China
| | - Qing Zhang
- grid.453074.10000 0000 9797 0900The First Affiliated Hospital and Clinical Medical College, Henan University of Science and Technology, 471000 Luo Yang, China
| | - Yi Hou
- Luoyang City CDC, Luo Yang, 471000 China
| | - Kena Song
- grid.453074.10000 0000 9797 0900School of Medical Technology and Engineering, Henan University of Science and Technology, Luo Yang, 471000 China
| | - Yun Xue
- grid.453074.10000 0000 9797 0900School of Medical Technology and Engineering, Henan University of Science and Technology, Luo Yang, 471000 China
| |
Collapse
|
7
|
Detection of Isoniazid and Rifampin Resistance in Mycobacterium tuberculosis Clinical Isolates from Sputum Samples by High-Resolution Melting Analysis. Curr Microbiol 2022; 79:257. [PMID: 35852629 DOI: 10.1007/s00284-022-02960-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/27/2022] [Indexed: 11/03/2022]
Abstract
The effective management of multidrug-resistant tuberculosis (MDR-TB) and the need for rapid and accurate screening of rifampin (RIF) and isoniazid (INH)-resistant Mycobacterium tuberculosis (Mtb) isolates are the most fundamental and difficult challenges facing the global TB control. The present study aimed to compare the diagnostic accuracy of high-resolution melting-curve analysis (HRMA) in comparison to multiplex allele-specific PCR (MAS-PCR) and xpert MTB/RIF as well as the conventional drug-susceptibility test (DST) and gene sequencing for the detection of INH and RIF resistance in the Mtb isolates. In the present study, a total of 431 Mtb isolates including 11 MDR (%2.55), 7 INH resistance (%1.62), two RIF resistance (%0.46), and 411 sensitive isolates were phenotypically confirmed. HRMA assay identified katG gene mutations and the mabA-inhA promoter region in 15 of 18 INH-resistant samples and rpoB gene mutations were successfully evaluated in 11 out of 13 RIF-resistant samples. The sensitivity and specificity of the HRMA method were 83.3% and 98.8% for INH and 84.6% and 99% for RIF, respectively. The most common mutation in RIF-resistance-determining region (RRDR) occurred at codon 531 (TCG → TTG)(84.6%) and then at codon 513 (CAA → GTA)(7.6%) and 526 (CAC → TAC) (7.6%), which resulted in the amino-acid changes. Also, 88.8% of INH-resistant samples had mutations in the katG gene and the mabA-inhA promoter region, of which the highest mutation occurred at codon 315 (AGC → ACC) of the katG gene. In conclusion, all these results indicated that the sensitivity and specificity of the HRM method were increased when the katG gene and the mabA-inhA promoter region were used as a target.
Collapse
|
8
|
Development and Application of a High-Resolution Melting Analysis with Unlabeled Probes for the Screening of Short-Tailed Sheep TBXT Heterozygotes. Animals (Basel) 2022; 12:ani12060792. [PMID: 35327188 PMCID: PMC8944613 DOI: 10.3390/ani12060792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary TBXT (c.333G > C; c.334G > T) has been identified as a molecular genetic marker in short-tailed sheep. This paper describes a high-resolution melting (HRM) analysis using unlabeled probes and asymmetric PCR for the detection of genetic variants of TBXT in short-tailed sheep populations. The detection results of this method are consistent with those of Sanger sequencing and can help farmers with marker-assisted breeding. Abstract The short-tailed phenotype has long been considered one of the best traits for population genetic improvement in sheep breeding. In short-tailed sheep, not only is tail fat eliminated but also the pubic area is exposed due to the lack of a tail covering, giving them an advantage in reproduction. Recent studies have shown that two linked mutations in sheep TBXT at nucleotides 333 and 334 are associated with the short-tailed phenotype. In the population of short-tailed sheep, several heterozygous mutants of this gene are found. In our research, we used high-resolution melting (HRM) to identify homozygous and heterozygous genotypes in a flock of short-tailed sheep and compared the results with those of Sanger sequencing, which were identical. This demonstrates that our established HRM method, a rapid and inexpensive genotyping method, can be used to identify homozygous and heterozygous individuals in short-tailed sheep flocks.
Collapse
|
9
|
Ma J, Liu H, Wang J, Li W, Fan L, Sun W. HIV-Negative Rifampicin Resistance/Multidrug-Resistant Extrapulmonary Tuberculosis in China from 2015 to 2019: A Clinical Retrospective Investigation Study from a National Tuberculosis Clinical Research Center. Infect Drug Resist 2022; 15:1155-1165. [PMID: 35340674 PMCID: PMC8943829 DOI: 10.2147/idr.s342744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background China is the region with a high global burden of rifampicin resistance/multidrug-resistant tuberculosis (RR/MDR-TB) and low HIV incidence. Our aim was to assess the clinical and demographic characteristics of RR/MDR-extrapulmonary tuberculosis (EPTB) from 2015 to 2019 to provide evidence for the prevention and control of the disease in high TB burden areas. Methods We investigated the clinical and demographic data of all MDR/RR-EPTB cases in a TB specialized hospital from China and compared the cases with the MDR/RR-pulmonary tuberculosis (PTB) patients over the same period. Results Of the RR/MDR-TB patients enrolled, 15.4 were EPTB. The most common anatomical site was pleural/chest wall (25.9%). Compared with RR/MDR-PTB, females were more likely to be susceptible to RR/MDR-EPTB (OR 1.65, 95% CI 1.52–1.77); the risk of RR/MDR-EPTB for 25–44 years group increased (OR 1.61, 95% CI 1.52–1.77), and then decreased with the increasing age (OR 1.48, 95% CI 0.74–1.69 for 44–65 years group and OR 2.23, 95% CI 0.98–2.71 for ≥65 years group); more likely to be newly diagnosed (p < 0.01) and less likely to to combine with diabetes (P < 0.01), more dependent on GeneXpert MTB/RIF (Xpert, 90.9%) for diagnosis, with significantly higher rates of pre-XDR/XDR and significantly lower favorable treatment outcomes (both p < 0.01). Conclusion There are clinical and demographic differences between RR/MDR-PTB and RR/MDR-PTB. Xper should be recommended at an early stage for suspected patients, and fluoroquinolones should be used cautiously for anti-infective therapy in this population.
Collapse
Affiliation(s)
- Jun Ma
- Department of Tuberculosis and Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Hongcheng Liu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Jingjing Wang
- Department of Emergency, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Wenting Li
- Department of Tuberculosis and Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Lin Fan
- Department of Tuberculosis and Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Wenwen Sun
- Department of Tuberculosis and Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
- Correspondence: Wenwen Sun; Lin Fan, Department of Tuberculosis and Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, People’s Republic of China, Email ;
| |
Collapse
|