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Pal N, Ray R, Kundu S, Hazra A, Sau S, Sur S, Saha S, Mallick W. Burden of drug-resistant tuberculosis by the GeneXpert MTB/RIF assay and its clinico-epidemiological aspects at a tertiary care hospital in West Bengal. Indian J Med Microbiol 2024; 51:100703. [PMID: 39128730 DOI: 10.1016/j.ijmmb.2024.100703] [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: 12/05/2023] [Revised: 08/04/2024] [Accepted: 08/08/2024] [Indexed: 08/13/2024]
Abstract
Multidrug -resistant tuberculosis (MDRTB) is a serious threat to mankind. India has the highest number of MDRTB cases, although majority remain undiagnosed due to inadequate diagnostic infrastructure, leading to increased community transmission and mortality. This one-year observational retrospective study highlighted the effectiveness of the National Tuberculosis Elimination Program (NTEP) for prompt detection of drug-resistant TB by GeneXpert MTB/RIF assay and revealed its associated clinico-epidemiological factors. The overall detection rates of MTB and RRTB were 20.70 % and 20.86 % respectively. The pediatric population had 7.69 % rifampicin resistance, and HIV was strongly associated with the development of TB and RRTB (P < 0.01).
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Affiliation(s)
- Nupur Pal
- Microbiology Department, Institute of Postgraduate Medical Education and Research, 244 A.J.C.Bose Road, Kolkata, 700020, India.
| | - Raja Ray
- Microbiology Department, Institute of Postgraduate Medical Education and Research, 244 A.J.C.Bose Road, Kolkata, 700020, India
| | - Somenath Kundu
- Respiratory Medicine Department, Institute of Postgraduate Medical Education and Research, 244 A.J.C.Bose Road, Kolkata, 700020, India
| | - Avijit Hazra
- Pharmacology Department, Institute of Postgraduate Medical Education and Research, 244 A.J.C.Bose Road, Kolkata, 700020, India
| | - Singdha Sau
- Microbiology Department, Institute of Postgraduate Medical Education and Research, 244 A.J.C.Bose Road, Kolkata, 700020, India
| | - Suhita Sur
- Microbiology Department, Institute of Postgraduate Medical Education and Research, 244 A.J.C.Bose Road, Kolkata, 700020, India
| | - Shreya Saha
- Microbiology Department, Institute of Postgraduate Medical Education and Research, 244 A.J.C.Bose Road, Kolkata, 700020, India
| | - Wasim Mallick
- Microbiology Department, Institute of Postgraduate Medical Education and Research, 244 A.J.C.Bose Road, Kolkata, 700020, India
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Maulina N, Hayati Z, Hasballah K, Zulkarnain Z, Waraztuty I, Defadheandra A. Rifampicin Resistant Tuberculosis Among Presumptive Pulmonary Tuberculosis in Province Referral Hospital, Indonesia: Dynamic Cases of a 7-Year Report. J Res Health Sci 2024; 24:e00601. [PMID: 39072537 PMCID: PMC10999105 DOI: 10.34172/jrhs.2024.136] [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] [Received: 12/26/2023] [Revised: 01/14/2024] [Accepted: 02/20/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Indonesia has the second highest tuberculosis (TB) cases globally. This study aimed to determine the sociodemographic factors associated with TB and rifampicin-resistant tuberculosis (RR-TB) cases among presumptive pulmonary TB patients in Aceh Referral Hospital. Study Design: A retrospective cross-sectional study. METHODS A retrospective cross-sectional review of presumptive pulmonary TB patients having a sputum test at the clinical microbiology laboratory was conducted from January 2015 to December 2021. Patient characteristics and drug susceptibility data were abstracted from the hospital information system of TB (SITB) and analyzed by univariate and bivariate analysis. RESULTS The Mycobacterium tuberculosis (MTB) was detected in 32.8% sample (1,521/4,637). Of the TB-confirmed cases, 14.1% (215/1,521) were resistant to rifampicin (RR-TB). Most of them were male patients (71.63%), were in the age range of 35-54 years (48.7%), lived in rural areas of the country (56.3%), and were previously TB-treated cases (65.5%). Overall, 35-44-year-old patients (adjusted odds ratio [AOR]=2.11, 95% CI=1.25, 3.5, P<0.05) were more likely to have RR-TB compared to>65-year-old patients. Gender and residence were not associated with RR-TB (P>0.05). Case detection decreased in pandemic conditions (19.5% in 2019 to 13.9% and 7.91% in 2020 and 2021, respectively). CONCLUSION The findings revealed the dynamic cases and sociodemographic factors of TB and RR-TB in a province referral hospital in Indonesia for 7 years. The cases of TB and RR-TB among presumptive TB patients were 32.8% and 14.1%, respectively. The cases were found to be more noticeable in males, adults (45-54 years old), and patients residing in rural areas.
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Affiliation(s)
- Novi Maulina
- Microbiology Department, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, 23116, Indonesia
| | - Zinatul Hayati
- Microbiology Department, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, 23116, Indonesia
| | - Kartini Hasballah
- Pharmacology Department, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, 23116, Indonesia
| | - Zulkarnain Zulkarnain
- Physiology Department, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, 23116, Indonesia
| | - Ika Waraztuty
- Anatomy Department, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, 23116, Indonesia
| | - Azzaura Defadheandra
- Anatomy Department, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, 23116, Indonesia
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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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Akalu TY, Clements ACA, Xu Z, Bai L, Alene KA. Determinants of drug-resistant tuberculosis in Hunan province, China: a case-control study. BMC Infect Dis 2024; 24:198. [PMID: 38350860 PMCID: PMC10863170 DOI: 10.1186/s12879-024-09106-5] [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] [Received: 04/24/2023] [Accepted: 02/06/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Drug-resistant tuberculosis (DR-TB) is a major public health threat in Hunan Province, with an increasing clinical burden in recent years. This study aimed to identify socio-demographic and clinical factors associated with DR-TB in Hunan province, China. METHODS A case-control study was conducted in Hunan province. Cases were all DR-TB patients who were confirmed by culture and Drug susceptibility testing (DST) and enrolled at the DR-TB treatment center of Hunan Chest Hospital from 2013 to 2018. Controls were all Drug Susceptible TB (DS-TB) patients confirmed by DST and enrolled at the same hospital during the same period. A multivariable logistic regression model was fitted to identify factors significantly associated with DR-TB. RESULTS A total of 17,808 patients (15,534 DS-TB controls and 2274 DR-TB cases) were included in the study, with a mean age of 42.5 years (standard deviation (SD) ± 17.5 years) for cases and 46.1 years (SD ± 19.1 years) for controls. Age 15-64 years (Adjusted odds ratio (AOR = 1.5, 95% CI; 1.4, 1.8)), ethnic minorities (AOR = 1.5; 95% CI; 1.4, 1.8), and a history of previous TB treatment (AOR) = 1.84; 95% CI: 1.57, 2.15) was significantly associated with DR-TB. Being resident in a province outside Hunan was also a significant risk factor (AOR = 1.67; 1.27, 2.21) for DR-TB. CONCLUSION AND RECOMMENDATIONS To prevent the occurrence of DR-TB in Hunan Province, interventions should be targeted at high-risk demographic groups such as ethnic minorities, individuals of productive age, and residents living outside the province. Interventions must also be targeted to previously treated cases, suggesting the appropriateness of diagnosis, treatment, and follow-up. Understanding the risk factors at the province level helps design strategies for controlling DR-TB due to variations by socioeconomic differences, quality of health care, and healthcare access.
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Affiliation(s)
- Temesgen Yihunie Akalu
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia.
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Archie C A Clements
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Penninsula Medical School, University of Plymouth, Plymouth, UK
| | - Zuhui Xu
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Liqiong Bai
- TB Control Institute of Hunan Province, Changsha, China
| | - Kefyalew Addis Alene
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
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Sun J, Fan L, Zhao Y, Wu H, Li R, Tian Y, Cheng M, Ma X, Ma Y, Yang X, Shen A, Yu Y, Chen Y. Analysis of Drug-Resistant Tuberculosis in Children in Shenyang, China, 2017-2021. Infect Drug Resist 2023; 16:6983-6998. [PMID: 37933293 PMCID: PMC10625755 DOI: 10.2147/idr.s428720] [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: 08/03/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023] Open
Abstract
Objective Drug-resistant tuberculosis (DR-TB) in children seriously threatens TB control. Information on the epidemiology and characteristics of DR-TB in children in China is limited. We studied data in Shenyang Tenth People's Hospital to understand the DR-TB epidemiology in children in Shenyang. Design or Methods We retrospectively analyzed drug resistance testing data of pediatric TB patients between 2017 and 2021, and included 2976 clinically-diagnosed pediatric TB patients. We described the epidemiology of DR-TB and analyzed the trends of DR-TB incidence. The Kappa value was calculated to assess the agreement between MGIT 960 DST and Xpert MTB/RIF for detecting rifampicin resistance. Multivariate logistic regression was used to identify the risk factors for DR-TB in pediatric patients. Results Of the 2976 TB patients, 1076 were confirmed by MGIT 960 culture and/or Xpert MTB/RIF. Among the 806 patients identified by MGIT 960 culture, 232 cases (28.78%) were DR-TB. Resistance to the six drugs was in the following order: streptomycin (21.09%), isoniazid (9.35%), rifampin (15.01%), levofloxacin (6.20%), ethambutol (4.22%), and amikacin (3.23%). Alarmingly, 12.90% were MDR-TB (104/806), including 28 (3.47%) pre-XDR-TB. Of the 1076 pediatric TB patients, 295 (27.4%) developed DR-TB to any one drug (including 69 rifampicin-resistant cases identified by Xpert MTB/RIF only). No difference was found in the incidence of pediatric DR-TB between 2017 and 2021. Among 376 patients who were positive for both methods, using the MGIT 960 DST results as the gold standard, Xpert MTB/RIF's sensitivity for detecting rifampicin resistance was 91.38% and its specificity was 94.65%. Conclusion Between 2017 and 2021, the DR-TB incidence in children remained unchanged in Shenyang. RR-TB, MDR-TB, and even Pre-XDR-TB require attention in children with drug-resistant TB. Xpert MTB/RIF helped to detect more rifampicin-resistant pediatric patients; thus Xpert MTB/RIF should be widely used as an important complementary tool to detect rifampicin-resistant TB in children.
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Affiliation(s)
- Jiao Sun
- Tuberculosis Laboratory, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Lichao Fan
- Department of Tuberculosis, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Yanping Zhao
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Haoyu Wu
- Department of Tuberculosis, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Ran Li
- Department of Tuberculosis, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Yao Tian
- Department of Tuberculosis, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Moxin Cheng
- Department of Tuberculosis, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Xin Ma
- Tuberculosis Laboratory, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Yingying Ma
- Tuberculosis Laboratory, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Xinru Yang
- Tuberculosis Laboratory, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Adong Shen
- National Clinical Research Center for Respiratory Disease, Beijing, People’s Republic of China
| | - Yanhong Yu
- Tuberculosis Laboratory, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Yu Chen
- Department of Tuberculosis, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
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Mustafa ZUI, Khan AH, Harun SN, Salman M, Godman B. Antibiotic Overprescribing among Neonates and Children Hospitalized with COVID-19 in Pakistan and the Implications. Antibiotics (Basel) 2023; 12:646. [PMID: 37107008 PMCID: PMC10135218 DOI: 10.3390/antibiotics12040646] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
There are concerns with excessive antibiotic prescribing among patients admitted to hospital with COVID-19, increasing antimicrobial resistance (AMR). Most studies have been conducted in adults with limited data on neonates and children, including in Pakistan. A retrospective study was conducted among four referral/tertiary care hospitals, including the clinical manifestations, laboratory findings, the prevalence of bacterial co-infections or secondary bacterial infections and antibiotics prescribed among neonates and children hospitalized due to COVID-19. Among 1237 neonates and children, 511 were admitted to the COVID-19 wards and 433 were finally included in the study. The majority of admitted children were COVID-19-positive (85.9%) with severe COVID-19 (38.2%), and 37.4% were admitted to the ICU. The prevalence of bacterial co-infections or secondary bacterial infections was 3.7%; however, 85.5% were prescribed antibiotics during their hospital stay (average 1.70 ± 0.98 antibiotics per patient). Further, 54.3% were prescribed two antibiotics via the parenteral route (75.5%) for ≤5 days (57.5), with most being 'Watch' antibiotics (80.4%). Increased antibiotic prescribing was reported among patients requiring mechanical ventilation and high WBCs, CRP, D-dimer and ferritin levels (p < 0.001). Increased COVID-19 severity, length of stay and hospital setting were significantly associated with antibiotic prescribing (p < 0.001). Excessive antibiotic prescribing among hospitalized neonates and children, despite very low bacterial co-infections or secondary bacterial infections, requires urgent attention to reduce AMR.
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Affiliation(s)
- Zia UI Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan 57400, Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Penang, Malaysia
| | - Sabariah Noor Harun
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Penang, Malaysia
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore 54000, Pakistan
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow G4 0RE, UK
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman P.O. Box 346, United Arab Emirates
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Mohan S, Pujari V, Meshram P. Drug resistance patterns and treatment outcomes in DR-TB patients at a tertiary care centre in Mumbai. Indian J Tuberc 2023; 71 Suppl 1:S10-S14. [PMID: 39067940 DOI: 10.1016/j.ijtb.2023.01.006] [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] [Received: 10/31/2022] [Accepted: 01/11/2023] [Indexed: 07/30/2024]
Abstract
BACKGROUND Drug-resistant tuberculosis (DR-TB) is a major health problem and threatens Tuberculosis (TB) control and outcomes globally. India holds one-fourth of global DR-TB burden.1 AIMS: 1- To study drug resistance patterns and outcomes in DR-TB patients under National Tuberculosis Elimination Programme (NTEP) at a tertiary care-centre. 2- To correlate outcome of DR-TB with drug resistance patterns. METHODS It is a retrospective study of 302 Drug Resistant Tuberculosis patients from Jan 2020 to May 2022. Common mutations of drug resistance, pyrazinamide resistance in DR-TB patients, correlation of High dose Moxifloxacin sensitivity by Line Probe Assay (LPA) and drug sensitivity test (DST), outcome of DR-TB patients with drug resistance patterns and correlation of outcome of DR-TB patients with their initial body-weight were studied. RESULTS Kat G was the most common mutation in Isoniazid (96%) resistance for MDR TB as well as Isoniazid Mono-resistance TB (p = 0.001). 91% cases with MDR-TB were resistant to pyrazinamide. 51.2% cases had low dose Fluroquinolone resistance. 18.8% cases had low and high dose Fluroquinolone resistance. 8.5% cases had resistance to injectables. 21.7% of cases who were resistant to High dose Moxifloxacin on second line LPA were found to be sensitive on DST. Outcomes were not dependent on the LPA resistance patterns. Body-weight greater than 45 Kg at the time of initiation of treatment was associated with better outcomes (p = 0.007). CONCLUSION DR-TB patients are resistant to pyrazinamide in nearly all cases; hence pyrazinamide is not suitable for initial replacement sequence. Second line resistance doesn't impact outcome in DR-TB patients.
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Affiliation(s)
- Sanchit Mohan
- Grant Government Medical College, Mumbai, Flat-12, Swastik Apartment, JJ Hospital Campus, Byculla, Mumbai 400008, India.
| | | | - Priti Meshram
- Department of Pulmonary Medicine, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India
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Ali MM, Weldegebreal F, Kabew G, Urgesa K. Rifampicin resistant Mycobacterium tuberculosis and associated factors among presumptive pulmonary tuberculosis patients in Mogadishu, Somalia. SAGE Open Med 2023; 11:20503121221148603. [PMID: 36643204 PMCID: PMC9834785 DOI: 10.1177/20503121221148603] [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: 01/18/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
Background Multi-drug resistant Mycobacterium tuberculosis is a growing public health problem in developing countries including Somalia. Although, the prevalence of multi-drug resistant tuberculosis among new and retreated cases is high, data on GeneXpert- Mycobacterium tuberculosis/rifampicin-resistant assay, which is a surrogate marker for multidrug resistance, is not well explored in Mogadishu. Objectives To determine the prevalence of rifampicin-resistant Mycobacterium tuberculosis and its associated factors among presumptive pulmonary tuberculosis patients visiting tuberculosis centers in Mogadishu, Somalia. Methods A multicenter cross-sectional study was conducted in three tuberculosis treatment centers from March 12 to April 30, 2021. Laboratory professionals collected sputum sample consecutively from presumptive pulmonary tuberculosis participants and performed a GeneXpert assay to determine the rifampicin resistance. Socio-demographic and clinical data were collected using structured questionnaire. Logistic regression analyses were performed to assess factors associated with rifampicin resistance using an adjusted odds ratio at a 95% confidence interval. Statistical significance was considered at a p-value of less than 0.05. Results A total of 370 presumptive tuberculosis suspects were included; of whom 58.4% were females and the mean age of the participants was 44.3 ± 14 years. Mycobacterium tuberculosis was detected in 63 (17%) (95% confidence interval = 13.2-20.8) suspects. Of these the prevalence of rifampicin-resistant Mycobacterium tuberculosis was 35% (95% confidence interval = 30.2-39.8). Anti-tuberculosis treatment history (adjusted odds ratio = 4.1; 95% confidence interval = 1.91-6.75), monthly income less than $100 USD (adjusted odds ratio = 2.2; 95% confidence interval = 1.77-5.98) and being diagnosed with Asthma (adjusted odds ratio = 2.63; 95% confidence interval = 1.3-7.3) were significantly associated with rifampicin-resistant tuberculosis. Conclusion A considerable proportion of rifampicin-resistant tuberculosis is reported in these study settings. The strong association between multidrug resistance tuberculosis and patients' retreatment history of tuberculosis, low income, and co-morbidity with asthma highlights the need for more efforts in tuberculosis treatment and monitoring programs to limit the emergence of multi-drug resistant strain in the study areas.
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Affiliation(s)
- Mohamed Muhumed Ali
- College of Health and Medical Sciences
of Daha International University, Mogadishu, Somalia
| | - Fitsum Weldegebreal
- Department of Medical Laboratory
Sciences College of Health and Medical Sciences, Haramaya University, Harar,
Ethiopia
| | - Getachew Kabew
- Department of Medical Laboratory
Sciences College of Health and Medical Sciences, Haramaya University, Harar,
Ethiopia
| | - Kedir Urgesa
- Department of Medical Laboratory
Sciences College of Health and Medical Sciences, Haramaya University, Harar,
Ethiopia,Kedir Urgesa, Department of Medical
Laboratory Sciences College of Health and Medical Sciences, Haramaya University,
Harar, Oromia 235, Ethiopia.
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Understanding of Final Year Medical, Pharmacy and Nursing Students in Pakistan towards Antibiotic Use, Antimicrobial Resistance and Stewardship: Findings and Implications. Antibiotics (Basel) 2023; 12:antibiotics12010135. [PMID: 36671336 PMCID: PMC9854661 DOI: 10.3390/antibiotics12010135] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Antimicrobial resistance (AMR) is a leading public health threat, which is exacerbated by the high and inappropriate use of antibiotics. Consequently, there is a need to evaluate knowledge regarding antibiotic use, AMR and the readiness to implement antimicrobial stewardship programs (ASPs) among final year medical, pharmacy and nursing students in Pakistan. This reflects the high and increasing rates of AMR in the country, and students as future healthcare professionals (HCPs). A cross-sectional study was conducted among 1251 final year students from 23 public and private educational institutions in Punjab. The majority of the surveyed participants possessed good knowledge of antibiotic use, AMR and the potential causes of AMR. The most common sources of the information on antibiotics were smartphones (69.9%), peers (35.9%) and medical textbooks (30.6%). However, most surveyed participants were not fully prepared to participate in ASPs. They knew, though, how to reduce AMR by educating HCPs about appropriate prescribing, implementing ASPs and improving laboratory facilities. There was a significant association between antibiotic knowledge and causes of AMR with sex, family income and student type (p < 0.05). Being a student at a public sector university (OR = 4.809; CI = 3.261−7.094; p < 0.001) and age (OR = 0.524, CI = 0.327−0.842; p < 0.008) were among the key factors impacting students’ training on ASPs. Educational curricula must be improved to include more information about appropriate antibiotic use and ASPs, along with sufficient training, workshops and clinical rotations in the final year, to fully equip students by graduation.
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Singhal R, Sah GC, Sethi P, Singh A, Kumar G, Myneedu VP. Detection of multidrug and extensively drug-resistance and mutation pattern in geriatric patients from North Indian referral institute. Indian J Tuberc 2022; 69 Suppl 2:S287-S294. [PMID: 36400525 DOI: 10.1016/j.ijtb.2022.10.016] [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] [Received: 10/11/2021] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Geriatric population are predisposed to reactivation to tuberculosis (TB) and multi-drug resistance (MDR) due to deteriorated immune system. Limited data is available in this population hence present study is undertaken to study drug resistance and associated mutations among geriatric presumptive DR-TB patients by genotypic methods METHODS: From October 2011 to December 2018, demographic characteristics of enrolled patients was collected. Smear-positive processed sputum samples were subjected directly while cultures positive for Mycobacterium Tuberculosis (MTB) from smear-negative pulmonary and all extra-pulmonary samples were subjected to LPA. The LPA used were Genotype MTBDR plus (1st line LPA) for detection of susceptibility to rifampicin (RIF) and isoniazid (INH) and Genotype MTBDR sl (2nd line LPA), for susceptibility to fluoroquinolones (FQ) and aminoglycosides (AG). RESULTS Total of 2041 samples were received from presumptive MDR-TB patients above 60 years of age during study period, of which 1406; 68.9% were within 60-70 year followed by 495; 24.3% within 71-80 year and 140; 6.9% more than 80 years. Total of 1055 MTB were detected, of which those diagnosed as RIF resistant were 117/1055; 11.2% including 89/1055; 8.5% MDR-TB and resistance to INH was in 84/1055; 8%. Total 67, 2nd line LPA gave valid results, of which 19/67 (28.4%) isolates were resistant to only FQ, and one isolate was resistant to AG. CONCLUSION Study finding highlights need for dedicated efforts for diagnosis, and treatment of geriatric tuberculosis. Suitable intervention at programmatic country level at country will help in strengthening tuberculosis control strategies in this population.
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Affiliation(s)
- Ritu Singhal
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India.
| | - Grish C Sah
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India
| | - Prabhpreet Sethi
- Department of TB and Chest, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India
| | - Anjali Singh
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India
| | - Gavish Kumar
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India
| | - Vithal Prasad Myneedu
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India
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Zhang SJ, Yang Y, Sun WW, Zhang ZS, Xiao HP, Li YP, Zhang ZM, Fan L. Effectiveness and safety of bedaquiline-containing regimens for treatment on patients with refractory RR/MDR/XDR-tuberculosis: a retrospective cohort study in East China. BMC Infect Dis 2022; 22:715. [PMID: 36038829 PMCID: PMC9422092 DOI: 10.1186/s12879-022-07693-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Refractory rifampicin-resistant/multidrug resistant/extensively-drug resistant tuberculosis (RR/MDR/XDR-TB) were defined as patients infected with Mycobacterium tuberculosis (MTB) resistant to rifampicin(RR-TB), or at least resistant to rifampicin and isoniazid (MDR-TB) or added resistant to fluoroquinolones (FQs) and one of second line injectable agents (XDR-TB), a patient for whom an effective regimen (fewer than 4 effective agents due to adverse events (AEs) or multiple drug resistances) cannot be developed. To compare the effectiveness and safety of bedaquiline (BDQ)-containing and BDQ-free regimens for treatment of patients with refractory RR/MDR/XDR-TB. METHODS Patients with refractory RR/MDR/XDR-TB receiving BDQ-containing regimens (BDQ group, n = 102) and BDQ-free regimens (non-BDQ group, n = 100) satisfied with included criteria were strictly included in this retrospective historical control study across East China. Culture conversion, treatment outcome, cavity closing rate, and AEs were compared between two groups. RESULTS The baseline characteristics involved all possible aspects of patients were well balanced between two groups (p > 0.05). Culture conversion rates in the BDQ group at month 3 (89.2% vs. 66.0%), month 6 (90.2% vs 72.0%), month 9 (91.2% vs. 66.0%), and month 12 (94.1% vs 65.0%) were all significantly higher than those in non-BDQ group (p < 0.001). Similar results were observed in the cavity closing rate at month 9 (19.6% vs 8.0%, p = 0.0) and month 12 (39.2% vs 15.0%, p < 0.001). Patients receiving BDQ-containing regimens had more treatment success than those receiving BDQ-free regimens (p < 0.001; cure rate, 69.6% vs. 45.0%; complete the treatment, 22.5% vs. 18.0%; treatment success, 92.2% vs. 63.0%); the use of BDQ and combined with Linezolid or Clofazimine or Cycloserine were identified as independent predictors of treatment success and no culture reversion (P < 0.05). AEs were similarly reported in 26.5% of patients in the BDQ group and 19.0% in the non-BDQ group (p = 0.2). CONCLUSIONS BDQ-containing regimens resulted in better treatment outcomes and similar safety relative to BDQ-free regimens for patients with refractory pulmonary RR/MDR/XDR-TB.
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Affiliation(s)
- Shao-Jun Zhang
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai, 200433, China
| | - Yan Yang
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai, 200433, China
| | - Wen-Wen Sun
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai, 200433, China
| | - Zhong-Shun Zhang
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai, 200433, China
| | - He-Ping Xiao
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai, 200433, China
| | - Yu-Ping Li
- Department of Pharmacy, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China.
| | - Zhe-Min Zhang
- Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China.
| | - Lin Fan
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai, 200433, China.
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12
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Muhammad Dayyab F, Iliyasu G, Garba Ahmad B, Aliyu Umar I, Musa Shuaib N, Bajehson M, Muhammad Daiyab I, Akpala O, Remilekun O, Garba Habib A. Emerging threat of drug-resistant tuberculosis and trends in the era of COVID-19: A descriptive study from northwestern Nigeria. J Clin Tuberc Other Mycobact Dis 2022; 28:100319. [PMID: 35599722 PMCID: PMC9110314 DOI: 10.1016/j.jctube.2022.100319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Mycobacterium tuberculosis with resistance to first line and second line anti tuberculous drugs is a serious setback in the treatment of tuberculosis (TB). The COVID-19 pandemic constitutes a serious threat that could unwind the recent gains made thus far in the control of tuberculosis. This study aims to explore the pattern of drug resistant tuberculosis (DRTB) in our institution. We also aimed to explore the changing trends of TB in the era of the COVID-19 pandemic. Methods This descriptive study included all DRTB patients admitted and managed in the hospital between January 2018 and December 2020. We compare TB case detection in the facility before and after COVID-19 pandemic. Drug susceptibility testing were expressed as frequencies and percentages. Results The study found that there was 66.03%, 45.09% and 77.78% drop in case detection of drug-sensitive TB (DSTB), DRTB and Fluoroquinolone (FQ) resistant TB respectively in the year 2020 compared to 2019. The drop in cases was similar when the year 2020 was compared to 2018. Among the 132 patients in the cohort, resistance to isoniazid, fluoroquinolones and second-line injectable agents were reported as 23.48%, 12.88%, and 31.06% respectively. Conclusion We question the potential reason why a drop in tuberculosis cases was observed in the year 2020 and we alert the Nigerian authorities that COVID-19 control efforts going hand-in-hand with intensified TB case finding and surveillance efforts and initiating proper TB treatment for persons with active TB are urgently needed.
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Affiliation(s)
| | - Garba Iliyasu
- Department of Medicine, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Bashir Garba Ahmad
- Department of Medicine, Muhammad Abdullahi Wase Teaching Hospital, Kano, Nigeria
| | - Ibrahim Aliyu Umar
- Tuberculosis, Leprosy and Buruli Ulcer Control Program, Public Health and Disease Control Department, Ministry of Health, Kano, Nigeria
| | - Nura Musa Shuaib
- Field Presence Cluster, World Health Organization, Kano State, Nigeria
| | - Mamman Bajehson
- KNCV Tuberculosis Foundation, Kano Cluster Office, Kano, Nigeria
| | | | - Oji Akpala
- Infectious Disease Hospital, Kano, Nigeria
| | | | | | - For Kano TB Concilium Experts
- Infectious Disease Hospital, Kano, Nigeria
- Department of Medicine, College of Health Sciences, Bayero University, Kano, Nigeria
- Department of Medicine, Muhammad Abdullahi Wase Teaching Hospital, Kano, Nigeria
- Tuberculosis, Leprosy and Buruli Ulcer Control Program, Public Health and Disease Control Department, Ministry of Health, Kano, Nigeria
- Field Presence Cluster, World Health Organization, Kano State, Nigeria
- KNCV Tuberculosis Foundation, Kano Cluster Office, Kano, Nigeria
- Health Development Alternative Initiative, Kano, Nigeria
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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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Khan MA, Bilal W, Asim H, Rahmat ZS, Essar MY, Ahmad S. MDR-TB in Pakistan: Challenges, efforts, and recommendations. Ann Med Surg (Lond) 2022; 79:104009. [PMID: 35860138 PMCID: PMC9289334 DOI: 10.1016/j.amsu.2022.104009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 11/24/2022] Open
Abstract
Tuberculosis (TB), a global health concern is also a leading cause of mortality and morbidity across Pakistan affecting a major proportion of the population. The absence of an integrated system to control the spread of TB has led to a rise in multidrug resistant strains of TB (MDR-Tb) which do not exhibit any sensitivity towards the first line therapy for TB. Such adverse circumstances call for effective planning strategies to mitigate the health hazards of MDR-TB. This article briefly highlights the challenges encountered by the already burdened healthcare system and suggests relatively inexpensive approaches to tackle the ongoing crisis associated with MDR-TB on a national scale.
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Affiliation(s)
| | | | | | | | | | - Shoaib Ahmad
- District Head Quarters Teaching Hospital, Faisalabad, Pakistan
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15
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Massud A, Syed Sulaiman SA, Ahmad N, Shafqat M, Chiau Ming L, Khan AH. Frequency and Management of Adverse Drug Reactions Among Drug-Resistant Tuberculosis Patients: Analysis From a Prospective Study. Front Pharmacol 2022; 13:883483. [PMID: 35747749 PMCID: PMC9211428 DOI: 10.3389/fphar.2022.883483] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022] Open
Abstract
Drug-resistant tuberculosis (DR-TB) management is often linked with a higher rate of adverse drug reactions (ADRs) needing effective and timely management of these ADRs, which, if left untreated, may result in a higher rate of loss to follow-up of drug-resistant patients. Study objective: The study was aimed at prospectively identifying the nature, frequency, suspected drugs, and management approaches for ADRs along with risk factors of ADRs occurrence among DR-TB patients at Nishtar Medical University, Hospital, Multan, Pakistan. Materials and Methods: The prospective study included all the DR-TB patients enrolled for treatment from January 2016 to May 2017 at the study site. Patients were evaluated for the treatment-induced ADRs as per standard criteria of the National Tuberculosis Program, Pakistan. Multivariate logistic regression was used to assess the independent variables associated with the occurrence of ADRs. Results: Out of 271 DR-TB patients included in the final analysis, it was observed that 55 patients (20.3%) experienced at least three ADRs. A total of 50 (18.5%) patients experienced zero adverse effects, while 15 (5.5%), 33 (12.2%), and 53 (19.6%) patients experienced one, two, and four ADRs, respectively. Gastrointestinal disturbances (66.7%), nervous system disorders (59.4%), and electrolyte disturbances (55.7%) remained the highest reported ADRs during therapy, followed by arthralgia (49.1%), ototoxicity (24%), pruritic reactions/rash (12.9%), dyspnoea (12.5%), and tinnitus (8.8%). Pulmonary cavitation at the baseline visit (p-value 0.001, OR 3.419; 95% CI (1.694–6.902) was significantly associated with the occurrence of ADRs among DR-TB patients. Conclusion: The frequency of ADRs was high among the study cohort; however, these were managed effectively. Patients with recognized risk factors for ADRs occurrence need continuous clinical management efforts.
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Affiliation(s)
- Asif Massud
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia.,Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia
| | - Nafees Ahmad
- Faculty of Pharmacy, University of Balochistan, Quetta, Pakistan
| | - Muhammad Shafqat
- Programmatic Management of Drug-Resistant Tuberculosis (PMDT) Unit, Nishtar Medical University Hospital, Multan, Pakistan
| | - Long Chiau Ming
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah (PAPRSB), Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia
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Dai Z, Sadiq M, Kannaiah D, Khan N, Shabbir MS, Bilal K, Tabash MI. The dynamic impacts of environmental-health and MDR-TB diseases and their influence on environmental sustainability at Chinese hospitals. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:40531-40541. [PMID: 35353303 DOI: 10.1007/s11356-022-19593-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
The purpose of this study is to identify at what extent multidrug-resistant tuberculosis (MDR-TB) diseases effect on environmental health issues in selected provinces of Chinese hospitals. In survival analysis approach, this study employs the Cox proportional hazard model (CPM) to incorporate the duration of event, probability of occurrence of an event, and the issue of right censoring. An advantage of using CPM is that one does not need to specify the distribution of baseline hazard H0 (t) as it considers a common value for all units in population. The results indicate that male and travel expenditures have negative association with the duration of cure. Furthermore, the medical expenditures and the spatial characteristic of time expenditure have positive association with the duration of cure of MDR-TB patients. The inconsistent behavior of males in taking medicines as compared to females and males is also more prone to tuberculosis (TB).
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Affiliation(s)
- Zong Dai
- Institute for Development of Central China /Wuhan University, Wuhan, 430072, China
| | - Misbah Sadiq
- Department of Management Sciences, Al-Qasimia University, Sharjah, United Arab Emirates
| | - Desti Kannaiah
- C. H. Sandage School of Business, Graceland University, Lamoni, IA, 50140, USA
| | - Nasir Khan
- Institute of Business and Management Sciences, The University of Agriculture Peshawar, Peshawar, Pakistan
| | - Malik Shahzad Shabbir
- Department of Management Sciences, Riphah International University, Islamabad, Pakistan.
| | - Kanwal Bilal
- Department of Management Sciences, Comsat University, Lahore Campus, Lahore, Pakistan
| | - Mosab I Tabash
- College of Business, Al Ain University, Al-Ain, United Arab Emirates
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Katana GG, Ngari M, Maina T, Sanga D, Abdullahi OA. Tuberculosis poor treatment outcomes and its determinants in Kilifi County, Kenya: a retrospective cohort study from 2012 to 2019. Arch Public Health 2022; 80:48. [PMID: 35123570 PMCID: PMC8818215 DOI: 10.1186/s13690-022-00807-4] [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: 10/14/2021] [Accepted: 01/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background Tuberculosis (TB) is one of the leading causes of deaths in Africa, monitoring its treatment outcome is essential to evaluate treatment effectiveness. The study aimed to evaluate proportion of poor TB treatment outcomes (PTO) and its determinants during six-months of treatment at Kilifi County, Kenya. Methods We conducted a retrospective analysis of data from the TB surveillance system (TIBU) in Kilifi County, Kenya from 2012 to 2019. The outcome of interest was PTO (lost-to-follow-up (LTFU), death, transferred out, treatment failure, drug resistance) or successful treatment (cured or completed treatment). We performed time-stratified (at three months follow-up) survival regression analyses accounting for sub-county heterogeneity to determine factors associated with PTO. Results We included 14,706 TB patients, their median (IQR) age was 37
(28–50) years and 8,791 (60%) were males. A total of 13,389 (91%) were on first line anti-TB treatment (2RHZE/4RH), 4,242 (29%) were HIV infected and 192 (1.3%) had other underlying medical conditions. During 78,882 person-months of follow-up, 2,408 (16%) patients had PTO: 1,074 (7.3%) deaths, 776 (5.3%) LTFU, 415 (2.8%) transferred out, 103 (0.7%) treatment failure and 30 (0.2%) multidrug resistance. The proportion of poor outcome increased from 7.9% in 2012 peaking at 2018 (22.8%) and slightly declining to 20% in 2019 (trend test P = 0.03). Over two-thirds 1,734 (72%) poor outcomes occurred within first three months of follow-up. In the first three months of TB treatment, overweight ((aHR 0.85 (95%CI 0.73–0.98), HIV infected not on ARVS (aHR 1.72 (95% CI 1.28–2.30)) and year of starting treatment were associated with PTO. However, in the last three months of treatment, elderly age ≥50 years (aHR 1.26 (95%CI 1.02–1.55), a retreatment patient (aHR 1.57 (95%CI 1.28–1.93), HIV infected not on ARVs (aHR 2.56 (95%CI 1.39–4.72), other underlying medical conditions (aHR 2.24 (95%CI 1.41–3.54)) and year of starting treatment were positively associated with PTO while being a female (aHR 0.83 (95%CI 0.70–0.97)) was negatively associated with PTO. Conclusions Over two-thirds of poor outcomes occur in the first three months of TB treatment, therefore greater efforts are needed during this phase. Interventions targeting HIV infected and other underlying medical conditions, the elderly and retreated patients provide an opportunity to improve TB treatment outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00807-4.
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Assessment of Factors Associated with Unfavorable Outcomes among Drug-Resistant TB Patients: A 6-Year Retrospective Study from Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031574. [PMID: 35162598 PMCID: PMC8835434 DOI: 10.3390/ijerph19031574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/02/2022] [Accepted: 01/11/2022] [Indexed: 02/05/2023]
Abstract
The spread of drug-resistant tuberculosis (DR TB) poses significant challenges to the control and successful eradication of TB globally. The current retrospective study was designed to evaluate the treatment outcomes and identify the risk factors associated with unsuccessful outcomes among DR TB patients. A total of 277/308 eligible DR TB patients were enrolled for treatment at the programmatic management unit of DR TB at the Pakistan Institute of Medical Sciences, Islamabad between January 2014 and July 2019. Treatment outcomes were defined according to the WHO recommendations. Death, treatment failure, and lost to follow-up (LTFU) were collectively grouped as unsuccessful treatment outcomes, whereas cured and treatment completed were summed up together as successful treatment outcomes. Out of the total 277 patients, 265 (95.67%) were multidrug/rifampicin-resistant TB (MDR/RR-TB) cases, 8 (2.89%) were isoniazid resistant cases, and 4 (1.44%) were extensively drug-resistant ones. In the current cohort, a total of 177 (63.9%) achieved successful treatment outcomes. Among them, 153 (55.2%) were declared cured and 24 (8.7%) completed their treatment. Of the remaining 100 (36.1%) patients with unsuccessful outcomes, 60 (21.7%) died, 32 (11.5%) were LTFU, and 8 (2.9%) had failed treatment. The proportion of male patients was relatively higher (55.2%), within the age group of 21–40 years (47.3%) and lived in rural areas (66.8%). The multivariate analysis revealed that unsuccessful outcomes had a statistically significant association with being male (adjusted odds ratio, AOR: 1.92, 95% confidence interval (CI): 1.10–3.36), being in an age group above 60 years (AOR: 3.34, 95% CI: 1.09–10.1), suffering from any comorbidity (AOR: 2.69, 95% CI: 1.35–5.38), and the history of use of second-line drugs (AOR; 3.51, 95% CI 1.35–9.12). In conclusion, treatment outcomes among DR TB patients at the study site were poor and did not achieve the treatment success target (≥75%) set by the World Health Organization.
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Khursheed N, Asif S, Bano S, Ali MM, Adnan F. Susceptibility pattern of Mycobacterium tuberculosis over a period of five years at Indus Hospital and Health Network, Karachi, Pakistan. Pak J Med Sci 2022; 38:399-404. [PMID: 35310805 PMCID: PMC8899881 DOI: 10.12669/pjms.38.icon-2022.5778] [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: 10/26/2021] [Accepted: 11/13/2021] [Indexed: 11/15/2022] Open
Abstract
Objective To determine the susceptibility pattern and frequency of isolation of multidrug, pre-extensively drug and extensively drug resistant TB in a tertiary care hospital in Karachi, Pakistan. Method A cross-sectional study was designed. Samples received in the lab were processed for growth and sensitivity testing of Mycobacterium tuberculosis. Isolation of MTB was done on Mycobacteria growth indicator tube (MGIT) followed by identification using MPT64. Samples were than evaluated for drug sensitivity against first and second-line antimycobacterial drugs. Statistical analysis was performed using SPSS version 24.0. Results Of the 20014 samples received, 23.1% were identified as Mycobacterium tuberculosis. Drug sensitivity testing was performed on 95.9% isolates. Fifty-two percent samples were from males and 48% female patients. The study found statistically non-significant relationship between gender and likelihood of disease with drug-resistant (DR)-MTB organisms. The rate of isolation of MDR-TB was highest (43%) among ages 25-55 years and previously treated patients compared to newly diagnosed patients (62% vs 36%). Among MTB positive samples, 91.5% were pulmonary while 8.5% were extrapulmonary samples. Extrapulmonary samples were more likely to be sensitive to antimycobacterial drugs. The highest resistance was observed against Isoniazid (pulmonary=58%; extrapulmonary=12.7%), Rifampicin (pulmonary=58.7%; extrapulmonary=8.2%), and Levofloxacin (pulmonary=29.2%; extrapulmonary=20%). Conclusion A considerable number of drug resistant tuberculosis cases were identified in the present study. It is essential to develop further strategies to reduce the spread of this disease.
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Affiliation(s)
- Nazia Khursheed
- Dr. Nazia Khursheed, FCPS Microbiology. Department of Microbiology, Indus Hospital and Health Network, Korangi Campus, Karachi, Pakistan
| | - Sunil Asif
- Sunil Asif, F.Sc. Department of Microbiology, Indus Hospital and Health Network, Korangi Campus, Karachi, Pakistan
| | - Safia Bano
- Safia Bano, M.Phil. Department of Microbiology, Indus Hospital and Health Network, Korangi Campus, Karachi, Pakistan
| | - Maria Mushtaq Ali
- Maria Mushtaq Ali, M.Sc in Biochemistry. Indus Hospital Research Center, Indus Hospital and Health Network, Korangi Campus, Karachi, Pakistan
| | - Fareeha Adnan
- Fareeha Adnan, FCPS Microbiology. Department of Microbiology, Indus Hospital and Health Network, Korangi Campus, Karachi, Pakistan
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Abdullah SF. Sociodemographic profile of mono rifampicin-resistant (RR) cases among pulmonary tuberculosis patients, Erbil, Iraq, 2015–2020. MEDICAL JOURNAL OF BABYLON 2022. [DOI: 10.4103/mjbl.mjbl_75_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mbuh TP, Wandji A, Keugni L, Mboh S, Ane-Anyangwe I, Mbacham WF, Meriki HD. Predictors of Drug-Resistant Tuberculosis among High-Risk Population Diagnosed under National Program Conditions in the Littoral Region, Cameroon. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8817442. [PMID: 34840984 PMCID: PMC8626195 DOI: 10.1155/2021/8817442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 04/21/2021] [Accepted: 10/19/2021] [Indexed: 12/13/2022]
Abstract
Multiple drug resistance TB (MDR-TB) has greatly jeopardized the effective control of tuberculosis in Africa. This study is aimed at determining the incidence and predictors of drug resistant-TB amongst bacteriologically diagnosed cases in the Littoral region of Cameroon. This was a descriptive cross-sectional survey conducted from January 2016 to December 2017. A total of 1665 participants were enrolled from 32 diagnostic and treatment centers (DTCs) in the Littoral region. Demographic, clinical, socioeconomic, and behavioral data were obtained using a pretested structured questionnaire. Drug susceptibility testing was performed using Gene Xpert MTB/RIF assay and line probe assay (LPA). Consent was obtained from participant/guidance. Data analysis was carried with SPSS version 21. Univariate and multiple logistic regression was performed at 5% significance level. The incidence of rifampicin and MDR-TB was 86 (5.2%) and 75 (4.5%), respectively. More (11.3%) cases of drug resistance were diagnosed in 2016 compared to 2017 (3.7%). Eleven (0.7%) were resistant to rifampicin only. A total of 19 (4.4%) cases of rifampicin resistance were detected from newly diagnosed cases and 67 (5.4%) from previously retreated cases. Pre-XDR-TB was detected in 2 (2.7%) of the MDR-TB cases amongst whom 1 (1.3%) was extensive drug resistance TB (XDR-TB). Age greater than 60 years old (OR = 4.98, p = 0.047), being married (OR = 1.91, p = 0.006), being currently incarcerated (OR = 1.74, p = 0.027), and having contact with known TB cases (OR = 1.88, p = 0.007) were associated to MDR-TB in a univariate analysis. This study highlights the declining rates of TB drug resistance in the region over the years probably due to the introduction of Gene Xpert that results in early detection of RR-TB. It also shows that age greater than 60 years, being married, and incarcerated are predictors of drug resistant-TB, while the year of patient enrolment and previous exposure to TB treatment were independent predictors of drug resistance in the Littoral region of Cameroon.
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Affiliation(s)
- Teyim Pride Mbuh
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Cameroon
- Tuberculosis Reference Laboratory Douala, Cameroon
| | - Adeline Wandji
- Littoral Regional Technical Group for the Control of Tuberculosis/Littoral Regional Delegation for Public Health, Cameroon
| | | | | | - Irene Ane-Anyangwe
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Cameroon
| | | | - Henry Dilonga Meriki
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Cameroon
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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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Seifert M, Aung HT, Besler N, Harris V, Mar TT, Colman RE, Rodwell TC, Aung ST. Age and sex distribution of Mycobacterium tuberculosis infection and rifampicin resistance in Myanmar as detected by Xpert MTB/RIF. BMC Infect Dis 2021; 21:781. [PMID: 34372793 PMCID: PMC8351356 DOI: 10.1186/s12879-021-06296-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/31/2021] [Indexed: 11/28/2022] Open
Abstract
Background Detection of tuberculosis disease (TB) and timely identification of Mycobacterium tuberculosis (Mtb) strains that are resistant to treatment are key to halting tuberculosis transmission, improving treatment outcomes, and reducing mortality. Methods We used 332,657 Xpert MTB/RIF assay results, captured as part of the Myanmar Data Utilization Project, to characterize Mtb test positivity and rifampicin resistance by both age and sex, and to evaluate risk factors associated with rifampicin resistance. Results Overall, 70% of individuals diagnosed with TB were males. Test positivity was higher among males (47%) compared to females (39%). The highest positivity by age occurred among individuals aged 16–20, with test positivity for females (65%) higher than for males (57%). Although a greater absolute number of males were rifampicin resistant, a greater proportion of females (11.4%) were rifampicin resistant as compared to males (9.3%). In the multivariate model, history of previous treatment, age less than 30, testing in the Yangon region, and female sex were significantly positively associated with rifampicin resistance after adjusting for HIV status and year test was performed. Conclusions Our results indicate that young adults were more likely to test positive for TB and be identified as rifampicin resistant compared to older adults.
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Affiliation(s)
- Marva Seifert
- University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
| | | | - Nicole Besler
- University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Victoria Harris
- FIND, the global alliance for diagnostics, Campus Biotech, 9 Chemin des Mines -, 1202, Geneva, Switzerland
| | - Tin Tin Mar
- Ministry of Health and Sports, Office No. 4, Naypyitaw, Myanmar
| | - Rebecca E Colman
- University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Timothy C Rodwell
- University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Si Thu Aung
- Ministry of Health and Sports, Office No. 4, Naypyitaw, Myanmar
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Arif A, Ahmad E, Khan FN, Fatima R. A cohort study analyzing the impact of socioeconomic and spatial characteristics alongside treatment regimens on the environmental-health outcomes of the MDR-TB treatment in Pakistan. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:34953-34967. [PMID: 33661501 DOI: 10.1007/s11356-021-13196-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/24/2021] [Indexed: 06/12/2023]
Abstract
This study identifies and analyzes a number of factors that correlate with the environmental-health outcome of multi-drug resistance tuberculosis (MDR-TB) treatment in Pakistan. Survival analysis is carried out by applying the multivariable Cox Proportional Hazard model on secondary data of 369 patients registered at three main MDR-TB sites in Pakistan during 2012-2017. Results show that there is no difference in survival of patients between the two treatment arms, hospital and ambulatory care. Male gender and travel expenditure are found to be negatively associated with the environmental-health outcome, whereas spatial characteristic of time expenditure is positively related to it supporting distance bias approach. Medical expenditure is also positively related to the environmental-health outcome. The study concludes that availability of affordable and accessible health services, better environmental conditions, and ambulatory care based on WHO recommendation as well as health education along with social protection schemes should be ensured by the government to improve environmental-health outcome in the resource-scarce setting in Pakistan.
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Affiliation(s)
- Ankasha Arif
- School of Economics, Quaid-i-Azam University, Islamabad, Pakistan.
| | - Eatzaz Ahmad
- School of Economics, Quaid-i-Azam University, Islamabad, Pakistan
| | | | - Razia Fatima
- National Tuberculosis Control Program, Ministry of Health, Pakistan, EPI building, F block, PM Health Complex, Chak Shahzad, Islamabad, Pakistan
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Al-Shahrani MS, Hakami MI, Younis MA, Fan HA, Jeraiby MA, Alraey Y. Prevalence of primary anti-tuberculosis drug resistance at the tertiary center in Saudi Arabia and associated risk factors. Saudi Med J 2021; 42:728-734. [PMID: 34187916 PMCID: PMC9195529 DOI: 10.15537/smj.2021.42.7.20200797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To estimate the prevalence mono-resistant tuberculosis (MR-TB) and multidrug resistant TB (MDR-TB), and evaluate the risk factors associated with the drug-resistant tuberculosis (DR-TB). METHODS A descriptive, retrospective study was applied, utilizing the TB patients' medical records at King Fahd Armed Forces Hospital (KFAFH), Jeddah, Saudi Arabia. The records of patients notified between 2000 and 2018 were reviewed and culture positive cases for Mycobacterium tuberculosis species were included. Moreover, the risk factors included were age, gender, smoking history, renal disease, liver disease, hyperbilirubinemia, diabetes mellitus, and human immunodeficiency virus (HIV). RESULTS Nine hundred and one cases in entirety were involved in the research, out of which 193 had drug-resistant tuberculosis (DR-TB) (21.4%). Out of the 21.4% DR-TB, 91.7% were MR-TB and 8.3% were MDR-TB. The highest MR prevalence was for pyrazinamide at 33.4%, while the lowest resistance was for ethambutol at 7.1%. For the risk factors of drug-resistant TB, only age depicted a statistically significant (p<0.01) but weak negative (r= -0.145) correlation with anti-TB drug resistance. CONCLUSION Rates of DR-TB reported in the study are considered higher compared to the recently reported national and international rates. According to the results, only younger people are at risk of developing DR-TB. Moreover, genetic mutation may play a role in drug resistance among our cases specifically for pyrazinamide monoresistance.
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Affiliation(s)
- Mohammed S. Al-Shahrani
- From the Department of Medical Laboratory (Al-Shahrani), Department of Pulmonary Medicine (Younis, Fan), King Fahd Armed Forces Hospital, Jeddah; Saudi Ministry of Health (Hakami), King Fahd Central Hospital; from the Biochemistry Department (Jeraiby), Faculty of Medicine, Jazan University, Jazan; and from Department of Clinical Laboratory Sciences (Alraey), College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Majed I. Hakami
- From the Department of Medical Laboratory (Al-Shahrani), Department of Pulmonary Medicine (Younis, Fan), King Fahd Armed Forces Hospital, Jeddah; Saudi Ministry of Health (Hakami), King Fahd Central Hospital; from the Biochemistry Department (Jeraiby), Faculty of Medicine, Jazan University, Jazan; and from Department of Clinical Laboratory Sciences (Alraey), College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Mahmoud A. Younis
- From the Department of Medical Laboratory (Al-Shahrani), Department of Pulmonary Medicine (Younis, Fan), King Fahd Armed Forces Hospital, Jeddah; Saudi Ministry of Health (Hakami), King Fahd Central Hospital; from the Biochemistry Department (Jeraiby), Faculty of Medicine, Jazan University, Jazan; and from Department of Clinical Laboratory Sciences (Alraey), College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Hanan A. Fan
- From the Department of Medical Laboratory (Al-Shahrani), Department of Pulmonary Medicine (Younis, Fan), King Fahd Armed Forces Hospital, Jeddah; Saudi Ministry of Health (Hakami), King Fahd Central Hospital; from the Biochemistry Department (Jeraiby), Faculty of Medicine, Jazan University, Jazan; and from Department of Clinical Laboratory Sciences (Alraey), College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Mohammed A. Jeraiby
- From the Department of Medical Laboratory (Al-Shahrani), Department of Pulmonary Medicine (Younis, Fan), King Fahd Armed Forces Hospital, Jeddah; Saudi Ministry of Health (Hakami), King Fahd Central Hospital; from the Biochemistry Department (Jeraiby), Faculty of Medicine, Jazan University, Jazan; and from Department of Clinical Laboratory Sciences (Alraey), College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Yasser Alraey
- From the Department of Medical Laboratory (Al-Shahrani), Department of Pulmonary Medicine (Younis, Fan), King Fahd Armed Forces Hospital, Jeddah; Saudi Ministry of Health (Hakami), King Fahd Central Hospital; from the Biochemistry Department (Jeraiby), Faculty of Medicine, Jazan University, Jazan; and from Department of Clinical Laboratory Sciences (Alraey), College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
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Khan AF, Sajjad A, Mian DA, Tariq MM, Jadoon UK, Abbas M, Shakeel K, Saeed N, Abbas K. Co-infection With Hepatitis B in Tuberculosis Patients on Anti-tuberculosis Treatment and the Final Outcome. Cureus 2021; 13:e14433. [PMID: 33996299 PMCID: PMC8114963 DOI: 10.7759/cureus.14433] [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] [Accepted: 04/12/2021] [Indexed: 11/05/2022] Open
Abstract
Background The occurrence of both tuberculosis (TB) and concomitant hepatitis B virus (HBV) is likely to be associated with poor patient outcomes and poor treatment response. Objective To assess whether tuberculosis patients with concomitant hepatitis B virus infection were prone to poorer outcomes and treatment response. Methodology A case-control study was undertaken at the Tuberculosis Centre, DHQ Bagh Azad Kashmir and Pulmonology Department, Lady Reading Hospital, Peshawar, between March 2020 and August 2020. All patients with diagnosed tuberculosis and coinfection with hepatitis B were labeled as the case group while those with only tuberculosis acted as the control. All patients with tuberculosis were managed on a directly observed treatment strategy (DOTS). Non-compliant patients and those without complete data were excluded from the study. All data regarding socio-demographics, laboratory investigations, and clinical characteristics were recorded in a predefined proforma. Patients were considered to have good treatment outcomes when patients completed the treatment or had a negative smear at six months of treatment. The Statistical Package for the Social Sciences (SPSS) version 26 (IBM Corp, Armonk, NY) was used for the data analysis. Results A total of 178 patients were enrolled in the study. It was found that patients with concomitant hepatitis B had significantly poorer outcomes as compared to patients who did not have hepatitis B (<0.001). Similarly, TB and hepatitis B patients were significantly associated with severe tuberculosis (<0.001) and required a higher frequency of retreatment (<0.001). Conclusion Our study reports a strong association between the treatment response of patients with tuberculosis with an added hepatitis B infection. Furthermore, a larger number of patients with hepatitis B had severe tuberculosis as compared to those without hepatitis B.
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Affiliation(s)
- Amir F Khan
- Surgery, Abbas Institute of Medical Sciences, Muzaffarabad, PAK
| | - Ahsan Sajjad
- Surgery, Khyber Teaching Hospital, Peshawar, PAK
| | - Dedaar A Mian
- Medicine, Lady Reading Hospital Medical Teaching Institute (MTI), Peshawar, PAK
| | | | | | - Muhammad Abbas
- Community Medicine, Khyber Medical College, Peshawar, PAK
| | | | - Nadia Saeed
- Zoology, Women University of Azad Jammu & Kashmir, Azad Jammu & Kashmir, PAK
| | - Kiran Abbas
- Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Saifullah A, Mallhi TH, Khan YH, Iqbal MS, Alotaibi NH, Alzarea AI, Rasheed M. Evaluation of risk factors associated with the development of MDR- and XDR-TB in a tertiary care hospital: a retrospective cohort study. PeerJ 2021; 9:e10826. [PMID: 33777510 PMCID: PMC7982078 DOI: 10.7717/peerj.10826] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/03/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Drug resistant tuberculosis (DR-TB) infringes substantial burden in terms of longer treatment duration, morbidity and mortality. Timely identification of patients at risks of DR-TB will aid individualized treatment. Current study was aimed to ascertain several factors associated with DR-TB among patients attending a tertiary care hospital. METHODS This retrospective study was conducted among patients with confirmed diagnosis of DR-TB and drug susceptible TB (DS-TB) seeking medical care from a tertiary care hospital during 2014-2019. The types of DR-TB included were rifampicin resistant tuberculosis (RR-TB), Multidrug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB). Appropriate statistical methods were implied to evaluate the factors associated with DR-TB. RESULTS Out of 580 patients, DS-TB was diagnosed in 198 (34.1%) patients while DR-TB was present in 382 patients. Of resistance cases, RR-TB, MDR-TB and XDR-TB were diagnosed in 176 (30.3%), 195 (33.6%) and 11 (1.9%) patients, respectively. Significant differences (P < 0.05) in demographics and clinico-laboratory characteristics were observed between patients with DS-TB and DR-TB. Logistic regression analysis revealed age ≤38 years (OR: 2.5), single marital status (OR: 11.1), tobacco use (OR: 2.9), previous treatment (OR: 19.2), treatment failure (OR: 9.2) and cavity on chest X-ray (OR: 30.1) as independent risk factors for MDR-TB. However, XDR-TB was independently associated with age group of ≤38 years (OR: 13.6), students (OR: 13.0), previous treatment (OR: 12.5), cavity on chest X-ray (OR: 59.6). The independent risk factors associated with RR-TB are age ≤38 years (OR: 2.8), females (OR: 5.7), unemployed (OR: 41.5), treatment failure (OR: 4.9), previous treatment (OR: 38.2) and cavity on chest X-ray (OR: 4.3). ROC curve analysis accentuate the excellent predictive accuracy of all logistic regression models as shown by AUC (0.968, P < 0.001) for MDR-TB, AUC (0.941, P < 0.001) for XDR-TB and AUC (0.962, P < 0.001) for RR-TB. CONCLUSIONS Current study demonstrates a sizeable extent of resistant cases among pulmonary TB patients. This study presaged significant risk of DR-TB among females, young adults, unemployed, smokers, patients with previous treatment failure and cavitation on chest X-ray. Timely identification of high risk patients will give pronounced advantages regarding appropriate choices of prevention, treatment and disease control.
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Affiliation(s)
- Amna Saifullah
- Institute of Pharmacy, Lahore College for Women University, Lahore, Punjab, Pakistan
- Current Affiliation: Department of Pharmacy, University of Lahore, Chenab Campus, Gujrat, Pakistan
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-kharj, Saudi Arabia
| | - Nasser Hadal Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Abdulaziz Ibrahim Alzarea
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Maria Rasheed
- Institute of Pharmacy, Lahore College for Women University, Lahore, Punjab, Pakistan
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Ali S, Khan MT, Khan AS, Mohammad N, Khan MM, Ahmad S, Noor S, Jabbar A, Daire C, Hassan F. Prevalence of Multi-Drug Resistant Mycobacterium tuberculosis in Khyber Pakhtunkhwa - A High Tuberculosis Endemic Area of Pakistan. Pol J Microbiol 2020; 69:1-5. [PMID: 32249555 PMCID: PMC7324855 DOI: 10.33073/pjm-2020-005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/20/2019] [Accepted: 01/08/2020] [Indexed: 12/03/2022] Open
Abstract
Anti-tuberculosis therapy involves the combination of drugs to hamper the growth of Mycobacterium tuberculosis (MTB). The emergence of multidrug-resistant tuberculosis (MDR-TB) is a global concern. Pakistan has been ranked 5th position in terms of a high burden of MDR-TB in the world. The aim of the current study was to investigate the prevalence of drug resistance in MTB in Khyber Pakhtunkhwa. Random samples were collected from 25 districts using the simple random sampling formula. All samples were processed in a biosafety level 3 laboratory for culture and drug susceptibility testing. Among 5759 presumptive tuberculosis (TB) cases, 1969 (34%) were positive. The proportion of TB was higher in females (39%) than males (29%), thus it represents a significant association between gender and tuberculosis (p < 0.05). People ages between 25 to 34 years were more likely to be infected with MTB (40%). Drug-resistant profile showed 97 (4.9%) patients were infected with MDR-TB. Streptomycin resistance was the highest and was observed in 173 (9%) isolates followed by isoniazid in 119 (6%) isolates. The lowest resistance was observed to pyrazinamide (3%). The prevalence of MDR-TB (10.4%) among patients that previously received anti-tuberculosis treatment is seemingly high. A large-scale drug resistance survey is required to evaluate the drug resistance for better management of tuberculosis.
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Affiliation(s)
- Sajid Ali
- Quaid-i-Azam University , Islamabad , Pakistan
| | | | | | - Noor Mohammad
- Provincial TB Control Program , Khyber Pakhtunkhwa , Pakistan
| | | | - Sajjad Ahmad
- Provincial TB Control Program , Khyber Pakhtunkhwa , Pakistan
| | - Sadiq Noor
- University of Haripur , Khyber Pakhtunkhwa , Pakistan
| | - Abdul Jabbar
- University of Haripur , Khyber Pakhtunkhwa , Pakistan
| | - Cantillon Daire
- Brighton and Sussex Medical School , University of Sussex , Brighton , United Kingdom
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Prevalence of Antibiotic-Resistant Pulmonary Tuberculosis in Bangladesh: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2020; 9:antibiotics9100710. [PMID: 33080862 PMCID: PMC7602942 DOI: 10.3390/antibiotics9100710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Resistance to anti-tuberculosis (anti-TB) antibiotics is a major public health concern for many high-TB burden countries in Asia, including Bangladesh. Therefore, to represent the overall drug-resistance pattern against TB in Bangladesh, a systematic review and meta-analysis was conducted. Databases such as PubMed, Scopus, and Google Scholar were searched to identify studies related to antibiotic-resistant TB. A total of 24 studies covering 13,336 patients with TB were secured and included. The random-effects model was used to calculate the summary estimates. The pooled prevalence of any, mono, multi, poly, and extensive anti-TB antibiotic-resistances were 45.3% [95% CI: 33.5–57.1], 14.3% [95% CI: 11.4–17.2], 22.2% [95% CI: 18.8–25.7], 7.7% [95% CI: 5.6–9.7], and 0.3% [95% CI: 0.0–1.0], respectively. Among any first and second-line anti-TB drugs, isoniazid (35.0%) and cycloserine (44.6%) resistances were the highest, followed by ethambutol (16.2%) and gatifloxacin (0.2%). Any, multi, and poly drug-resistances were higher in retreatment cases compared to the newly diagnosed cases, although mono drug-resistance tended to be higher in newly diagnosed cases (15.7%) than that in retreatment cases (12.5%). The majority (82.6%) of the included studies were of high quality, with most not exhibiting publication bias. Sensitivity analyses confirmed that all outcomes are robust and reliable. It is concluded that resistance to anti-TB drugs in Bangladesh is rampant and fast growing. Therefore, the implementation of a nationwide surveillance system to detect suspected and drug-resistant TB cases, as well as to ensure a more encompassing treatment management by national TB control program, is highly recommended.
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Shivekar SS, Kaliaperumal V, Brammacharry U, Sakkaravarthy A, Raj CKV, Alagappan C, Muthaiah M. Prevalence and factors associated with multidrug-resistant tuberculosis in South India. Sci Rep 2020; 10:17552. [PMID: 33067551 PMCID: PMC7567814 DOI: 10.1038/s41598-020-74432-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 09/18/2020] [Indexed: 12/13/2022] Open
Abstract
India accounts for about one-fourth of the global burden of MDR-TB. This study aims to assess the prevalence and factors associated with tuberculosis drug resistance among patients from South India. MTBDRplus assay and MGIT liquid culture performed on 20,245 sputum specimens obtained from presumptive MDR-TB cases during a six-year period from 2013 to 2018 were analyzed retrospectively. Univariate and multivariate logistic regression analysis was carried out to evaluate factors associated with MDR, Rifampicin mono-resistance, and Isoniazid mono-resistance. MDR, Rifampicin mono- resistant and Isoniazid mono-resistant TB were found in 5.4%, 2.5%, and 11.4% cases of presumptive MDR-TB, respectively. Based on the rpoB gene, true resistance, hetero-resistance, and inferred resistance to Rifampicin was found in 38%, 29.3%, and 32.7% of the 1582 MDR cases, respectively. S450L (MUT3) was the most common rpoB mutation present in 59.4% of the Rifampicin resistant cases. Of the 3390 Isoniazid resistant cases, 72.5% had mutations in the katG gene, and 27.5% had mutations in the inhA gene. True resistance, heteroresistance, and inferred resistance accounted for 42.9%, 22.2%, and 17.3% of the 2459 katG resistant cases, respectively. True resistance, heteroresistance, and inferred resistance for the inhA gene were found in 54.5%, 40.7%, and 4.7% cases, respectively. MDR-contact (AOR 3.171 95% CI: 1.747–5.754, p-0.000) treatment failure (AOR 2.17595% CI: 1.703–2.777, p-0.000) and female gender (AOR 1.315 95% CI: 1.117–1.548, p-0.001), were positively associated with MDR-TB. Previous TB treatment did not show a significant positive association with MDR (AOR 1.113 95% CI: 0.801–1.546, p-0.523). Old age (AOR 0.994 95% CI: 0.990–0.999, p-0.023) and HIV seropositivity (AOR 0.580 95% CI: 0.369–0.911, p-0.018) were negatively associated with MDR-TB. Although Rifampicin mono-resistance had a positive association with treatment failure (AOR 2.509 95% CI: 1.804–3.490, p < .001), it did not show any association with previous TB treatment (AOR 1.286 95% CI: 0.765–2.164, p-0.342) or with history of contact with MDR-TB (AOR 1.813 95% CI: 0.591–5.560, p-0.298). However, INH mono-resistance showed a small positive association with the previous history of treatment for TB (AOR 1.303 95% CI: 1.021–1.662, p-0.033). It was also positively associated (AOR 2.094 95% CI: 1.236–3.548, p-0.006) with MDR-TB contacts. Thus INH resistance may develop during treatment if compliance has not adhered too and may be easily passed on to the contacts while Rifampicin resistance is probably due to factors other than treatment compliance. MDR-TB, i.e. resistance to both Rifampicin and Isoniazid, is strongly correlated with treatment failure, spread through contact, and not to treatment compliance. The temporal trend in this region shows a decrease in MDR prevalence from 8.4% in 2015 to 1.3% in 2018. A similar trend is observed for Rifampicin mono-resistance and Isoniazid mono-resistance, pointing to the effectiveness of the TB control program. The higher proportion of inferred resistance observed for Rifampicin compared with INH may indicate a surfeit of mechanisms that enable rifampicin resistance. Association of MDR-TB with age, gender, and HIV status suggest the role of the immune system in the emergence of the MDR phenotype.
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Affiliation(s)
- Smita S Shivekar
- Department of Microbiology, State TB Training and Demonstration Centre, Government Hospital for Chest Diseases, Puducherry, India
| | - Venkatesh Kaliaperumal
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Usharani Brammacharry
- Department of Genetics, Dr.A.L.M. Postgraduate Institute of Basic Medical Sciences, University of Madras, Tamil Nadu, Chennai, India.
| | | | - C K Vidya Raj
- Department of Microbiology, State TB Training and Demonstration Centre, Government Hospital for Chest Diseases, Puducherry, India
| | - Chitra Alagappan
- Department of Microbiology, State TB Training and Demonstration Centre, Government Hospital for Chest Diseases, Puducherry, India
| | - Muthuraj Muthaiah
- Department of Microbiology, State TB Training and Demonstration Centre, Government Hospital for Chest Diseases, Puducherry, India.
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Understanding how geographic, demographic and treatment history impact health outcomes of patients with multi-drug-resistant tuberculosis in Pakistan, 2014-2017. Epidemiol Infect 2020; 148:e253. [PMID: 32993828 PMCID: PMC7689600 DOI: 10.1017/s0950268820002307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Tuberculosis (TB) is one of the top 10 leading causes of morbidity and mortality worldwide [1]. In 2017, approximately 10 million people were infected with TB and 1.3 million patients faced mortality [1]. Patients with active TB can infect up to 10–15 people over a year. There is a greater risk of transmission in overcrowded areas with limited air ventilation including large family units, prisons and slums [1, 2]. Without proper diagnosis and treatment, roughly 45% of non-HIV positive TB patients face mortality [1]. With the help of global organizations and national TB treatment and control programmes, the global incidence of TB is declining by approximately 2% each year [1]. The World Health Organization (WHO) TB-strategy aims to end the TB epidemic and encourages partners to fund national TB programmes to improve diagnosis and treatment of TB. The goal is to ultimately decrease death rates by 90% and decrease incidence rates by 80% [1]. To achieve these goals, the decline in TB incidence needs to reach approximately 4–5% per year [1]. The WHO 2018 TB report identified multidrug resistant TB (MDR-TB) as the leading factor hindering that goal [1]. The incidence and spread of MDR-TB has drastically increased, where approximately 558 000 new cases of MDR-TB were diagnosed in 2017 causing more than 230 000 deaths globally [1]. MDR-TB is identified by resistance to the two most powerful anti-TB treatment drugs including isoniazid and rifampicin [3]. Patients with MDR-TB are required to start second-line anti-TB drugs (SLDs), which are limited, expensive, less effective and more toxic [1,2]. Therapy duration is one of the major limitations of second-line treatments, which may require up to two years of consistent use. Since TB affects mostly developing countries, long treatment durations and associated costs become a major challenge. In 2015, 15% of new TB cases were reported as MDR-TB, which drastically increased to 24% by 2017 [1]. Even with significant improvements in molecular tests and diagnostic methods, MDR-TB is still on the rise where the success rate of treatments is between 50 and 60% [1]. Additional characteristics including socioeconomic and sociocultural factors need to be considered when targeting and treating patients with MDR-TB.
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Mahmood MS, Bin-T-Abid D, Irshad S, Batool H. Analysis of Putative Epitope Candidates of Mycobacterium tuberculosis Against Pakistani Human Leukocyte Antigen Background: An Immunoinformatic Study for the Development of Future Vaccine. Int J Pept Res Ther 2020; 27:597-614. [PMID: 32922244 PMCID: PMC7472948 DOI: 10.1007/s10989-020-10111-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2020] [Indexed: 11/25/2022]
Abstract
Tuberculosis (TB), a chronic disease caused by Mycobacterium tuberculosis (Mtb), is a global health issue across the world. Pakistan ranks fifth among the countries, which are facing, a significantly great number of mortalities and morbidities due to TB. Unfortunately, all previously reported treatments are not successful for the eradication of TB. Here in this study, we report an emerging treatment option for this disease. We have applied immunoinformatics to predict highly conserved B and T-cell epitopes from Mtb, showing significant binding affinities to the frequent HLA alleles in the Pakistani population. A total of ten highly referenced and experimentally validated epitopes were selected from the Immune Epitope Database (IEDB), followed by their conservancy analysis using weblogos. The consensus sequences and variants derived from these sequences were examined, for their binding affinities, with prevalent HLA alleles of Pakistan. Moreover, the antigenic and allergenic natures of these peptides were also evaluated via Vaxijen and AllerTOP, respectively. Consequently, all potentially allergenic and non-antigenic, peptide fragments, were excluded from the analysis. Among all putative epitopes, three CD8 + T-cell epitopes were selected, as ideal vaccine candidates and, population coverage analysis revealed that the combination of these three peptides was covering, 67.28% Pakistani Asian and 57.15% mixed Pakistani populations. Likewise, eleven linear and six conformational or discontinuous B-cell epitopes were also marked as potential vaccine candidates based on their prediction score, non-allergenic nature, and antigenic properties. These epitopes, however, need the final validation via wet-lab studies. After their approval, these epitopes would be effective candidates for the future designing of epitope-based vaccines against Mtb infections in Pakistan.
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Affiliation(s)
- Malik Siddique Mahmood
- Institute of Biochemistry and Biotechnology, University of the Punjab, P. O box No. 54590, Lahore, Pakistan
| | - Duaa Bin-T-Abid
- Institute of Biochemistry and Biotechnology, University of the Punjab, P. O box No. 54590, Lahore, Pakistan
| | - Saba Irshad
- Institute of Biochemistry and Biotechnology, University of the Punjab, P. O box No. 54590, Lahore, Pakistan
| | - Hina Batool
- Department of Life Science, School of Science, University of Management Technology, Lahore, Pakistan
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Pokam BDT, Yeboah-Manu D, Lawson L, Guemdjom PW, Okonu R, Madukaji L, Yhiler NY, Asuquo AE. Molecular Analysis of Mycobacterium tuberculosis Isolated in the North Central Zone of Nigeria. J Epidemiol Glob Health 2020; 9:259-265. [PMID: 31854167 PMCID: PMC7310797 DOI: 10.2991/jegh.k.191015.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 10/05/2019] [Indexed: 11/10/2022] Open
Abstract
Tuberculosis (TB) incidence in Nigeria is high, with a significant burden of TB/Human Immunodeficiency Virus (HIV). Genotyping and drug susceptibility of Mycobacterium tuberculosis Complex (MTBC) are important in order to improve the control of the disease. This study sought to determine drug susceptibility and genetic diversity of MTBC in the country. The sputum samples of 202 patients [133 (65.8%) males/69 (34.2%) females] were collected in the North Central zone of Nigeria and cultured using Lowenstein–Jensen medium. Immunochromatography for the primary identification and Drug Susceptibility Testing (DST) by proportion method, as well as IS6110 typing, regions of difference 1, 4, 9, 12, 702, and 711, and spoligotyping were carried out on the isolates. Following the DST on 202 isolates, 51 (25.2%) showed resistance to at least one drug. Multidrug resistance was observed in 29/202 (14.4%) cases. HIV positivity [37/202 (18.3%) patients] was associated with rifampicin 9/37 (24.3%) resistance (p = 0.012) as well as gender (p = 0.009). Of the 202 isolates, 150 (74.3%) were identified as the Cameroon sublineage, followed by the UgandaI, Haarlem, and West Africa 1 with 18 (8.9%), 10 (5%), and 6 (3%), respectively. The LAM10_CAM was the most prevalent genetic family [128/202 (63.4%)], with the shared international type 61 [111 (55%) isolates] the largest cluster. Gender (p = 0.038) and age (p = 0.015) had significant associations with the LAM10_CAM family but neither with HIV (p = 0.479) nor drug resistance. Rifampicin resistance in TB/HIV coinfected patient is a major concern in the study area. The Mycobacterium africanum lineage showed a marked decrease, and the need to educate females most at risk of TB/HIV coinfection is advocated.
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Affiliation(s)
- Benjamin David Thumamo Pokam
- Department of Medical Laboratory Science, Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Bacteriology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Dorothy Yeboah-Manu
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | | | - Prisca Wabo Guemdjom
- Department of Public Health, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Ruth Okonu
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | | | - Nchawa Yangkam Yhiler
- Department of Medical Laboratory Science, Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Department of Allied Health, Biaka University Institute, Buea, Cameroon
| | - Anne Ebri Asuquo
- Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, College of Medicine, University of Calabar, Calabar, Nigeria
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Wu X, Yang J, Tan G, Liu H, Liu Y, Guo Y, Gao R, Wan B, Yu F. Drug Resistance Characteristics of Mycobacterium tuberculosis Isolates From Patients With Tuberculosis to 12 Antituberculous Drugs in China. Front Cell Infect Microbiol 2019; 9:345. [PMID: 31828045 PMCID: PMC6849330 DOI: 10.3389/fcimb.2019.00345] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/25/2019] [Indexed: 11/29/2022] Open
Abstract
Objective: To investigate the drug resistance characteristics of Mycobacterium tuberculosis (MTB) isolates from patients with tuberculosis to 12 antituberculous drugs in China. Methods: All clinical isolates of MTB were isolated from patients with tuberculosis in Shanghai Pulmonary Hospital (SPH) during the period from January 1st to December 31th, 2018. Drug susceptibility testing (DST) was performed in micro plates with 12 antituberculous drugs in accordance with relevant guideline. Demographic information, including sex, age, and treatment history was recorded. Results: A total of 1,950 MTB isolates were included in this retrospective study which were isolated from 1,950 patients from 29 regions in China. One thousand six hundred and forty-four were initial treated and 306 were re-treated in the hospital. Two hundred and eight (10.67%, 208/1,950) cases were diagnosed as multidrug-resistant tuberculosis (MDR-TB), from which 74 (4.50%, 74/1,644) cases were initial treated, and the remaining (43.79%, 134/306) were re-treated cases. Besides, the percentage of extensively drug-resistant tuberculosis (XDR-TB) varied in such 3 different groups: 1.64% (32/1,950) in total cases, 0.30% (5/1,644) in initial treated cases and 8.82% (27/306) in re-treated cases. The total resistance rates were as follows: isoniazid (361, 18.51%), streptomycin (302, 15.49%), rifampin (241, 12.36%), ofloxacin (239, 12.26%), moxifloxacin (232, 11.90%), rifabutin (195, 10.00%), ethambutol (100, 5.13%), cycloserine (55, 2.82%), kanamycin (48, 2.46%), ethionamide (40, 2.05%), amikacin (39, 2.00%), and aminosalicylic acid (21, 1.08%). Rates of resistance to any drug in re-treated cases were significantly higher than in initial treated cases. The drug resistance rates of the 12 drugs were higher in males than in females. Patients older than 60 years had significantly lower percentages of MDR/XDR-TB (7.11 and 0.65%) than in younger age groups. The proportion of re-treated cases in Shanghai (11.38%, 88/773) was lower than that in other regions. Meanwhile, the percentages of MDR/XDR-TB in Shanghai (4.79 and 0.65%) were significantly lower than in other regions. Conclusions: In this study, we found higher proportion of MDR/XDR-TB among re-treated cases than initial treated cases in China and the drug resistance rate of tuberculosis varied with age, sex, and region, indicating that standardized anti-tuberculosis treatment can reduce the incidence of drug-resistant tuberculosis and the recurrence of tuberculosis.
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Affiliation(s)
- Xiaocui Wu
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jinghui Yang
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guangkun Tan
- Department of Clinical Laboratory, Shanghai University of Traditional Chinese Medical Attached Shuguang Hospital, Shanghai, China
| | - Haican Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yin Liu
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yinjuan Guo
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rongliang Gao
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Baoshan Wan
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fangyou Yu
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Tembo BP, Malangu NG. Prevalence and factors associated with multidrug/rifampicin resistant tuberculosis among suspected drug resistant tuberculosis patients in Botswana. BMC Infect Dis 2019; 19:779. [PMID: 31492099 PMCID: PMC6728949 DOI: 10.1186/s12879-019-4375-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/13/2019] [Indexed: 01/16/2023] Open
Abstract
Background To investigate the prevalence and factors associated with the prevalence of multidrug/rifampicin-resistant tuberculosis among suspected drug resistant tuberculosis patients in Botswana. Methods A retrospective review of medical records of suspected drug resistant tuberculosis patients receiving care at public health facilities in Botswana was conducted from January, 2013 and December, 2014. Patient characteristics and drug susceptibility data were abstracted from 2568 medical records on to a pre-tested checklist form. The prevalence of multidrug/rifampicin resistance was computed. Bivariate and multivariate logistic regression was carried out to determine the factors associated with the prevalence of multidrug/rifampicin in the study population. Results Overall, multidrug/ rifampicin - resistance among suspected drug resistant tuberculosis patients in Botswana were found in 139 (5.4%) cases with 1.3% among new cases and 7.7% among previously treated tuberculosis patients. Being a previously treated tuberculosis patient and having a positive smear were found to be factors associated with the prevalence of multidrug/rifampicin-resistant tuberculosis (p < 0.05). However, age, sex, living in urban area and HIV status were not associated with this disease (p > 0.05). Conclusion This study highlights a low burden of multidrug/rifampicin resistant tuberculosis among suspected drug resistant tuberculosis patients receiving care at public health facilities in Botswana. Strategies in controlling MDR/RR-TB should emphasize on effective implementation of Directly Observation Treatment – short course strategy, continuous surveillance of drug resistance cases, prevention of the development of new cases of MDR/RR-TB and to treat existing patients. Further interventions should focus on strengthening TB infection control activities.
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Affiliation(s)
| | - Ntambwe Gustav Malangu
- Department of Epidemiology and Biostatistics, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Jacobs MG, Pinto Junior VL. Brazilian cities profile, the occurence of tuberculosis an its drug-resistant form. CIENCIA & SAUDE COLETIVA 2019; 24:2379-2386. [PMID: 31340257 DOI: 10.1590/1413-81232018247.20532017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 09/15/2017] [Indexed: 11/22/2022] Open
Abstract
Tuberculosis is closely related to living conditions. This study classifies Brazilian municipalities according to the occurrence of tuberculosis (TB) and drug-resistant TB (DR-TB) cases and describes them with regard to the population's health conditions, tuberculosis control indicators, demographic and socioeconomic profile. In 2014, 327 municipalities reported DR-TB cases. Integrated regions of development or metropolitan regions accounted for 80.1% of national DR-TB cases. Municipalities with DR-TB cases had worse TB outcome indicators, but higher culture test percentages, and more inhabitants and better socioeconomic indicators. The 3,644 municipalities with TB cases, but without DR-TB cases, had the worst socioeconomic indicators among the three groups. The 1,594 municipalities without TB cases had the lowest rates of unemployment and AIDS detection and greater coverage of primary healthcare. The different profiles found in the study can sustain improved national interventions for TB and drug-resistant TB control in Brazil.
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Affiliation(s)
- Marina Gasino Jacobs
- Departamento de Saúde Coletiva, Faculdade de Ciências da Saúde, Universidade de Brasília. Campos Univ. Darcy Ribeiro s/n, Asa Norte. 70910-900 Brasília DF Brasil.
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Ukwamedua H, Omote V, Etaghene J, Oseji ME, Agwai IC, Agbroko H. Rifampicin resistance among notified pulmonary tuberculosis (PTB) cases in South-Southern Nigeria. Heliyon 2019; 5:e02096. [PMID: 31360790 PMCID: PMC6639537 DOI: 10.1016/j.heliyon.2019.e02096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/11/2019] [Accepted: 07/12/2019] [Indexed: 02/05/2023] Open
Abstract
Background Rifampicin resistant pulmonary tuberculosis (RR-PTB) remains a global health burden especially in low income countries and among HIV positive individuals. Objective This study seeks to measure the prevalence of RR-PTB among confirmed PTB cases in Delta State South-Southern, Nigeria and to determine the correlation between various factors affecting the prevalence of RRTB among notified pulmonary TB cases. Material and methods The study is cross-sectional and retrospective in design and was carried out in Delta State, South-Southern Nigeria among participants with notified pulmonary TB cases. Gene Xpert registers for the selected facilities (Central Hospital Warri, Central Hospital Sapele and Federal Medical Center Asaba) for the year 2017 were retrieved, data extracted and analyzed. Result Prevalence of RR-PTB was 7.3% (47/643). Majority (11.3% and 11.4%) of RR-PTB cases were among ages 0–20 and 61–80 years respectively. The male group and HIV negative participants gave rates of 9.1% and 7.8% respectively. Rates reported for location of residence revealed that Delta Central had a rate that doubled Delta South and tripled Delta North. Conclusion Although our study figures are lower when compared to other reports for the study region, age grades 0–20 and 61–80 years, the male gender and residence in Delta Central were highlighted as independent variables that influence the distribution of RR-PTB. While a call for the sustenance and if possible augmentation of control and eradication efforts is of high essence, further studies aimed at identifying and understanding co-variables to the ones highlighted are recommended.
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Affiliation(s)
- Henry Ukwamedua
- Department of Laboratory Services, Central Hospital Warri, Nigeria
| | - Victor Omote
- Department of Laboratory Services, Central Hospital Warri, Nigeria
| | - Johnson Etaghene
- Department of Public Health, Ministry of Health, Asaba, Delta State, Nigeria
| | - Matthew Ejike Oseji
- Department of Environmental Health Sciences, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Imaria Celia Agwai
- Department of Epidemiology and Medical Statistics, University of Ibadan, Nigeria
| | - Harrison Agbroko
- Department of Laboratory Services, Nigerian National Petroleum Cooperation Medical Centre Warri, Nigeria
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Okethwangu D, Birungi D, Biribawa C, Kwesiga B, Turyahabwe S, Ario AR, Zhu BP. Multidrug-resistant tuberculosis outbreak associated with poor treatment adherence and delayed treatment: Arua District, Uganda, 2013-2017. BMC Infect Dis 2019; 19:387. [PMID: 31064332 PMCID: PMC6503550 DOI: 10.1186/s12879-019-4014-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/24/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In August 2017, the Uganda Ministry of Health was notified of increased cases of multidrug-resistant tuberculosis (MDR-TB) in Arua District, Uganda during 2017. We investigated to identify the scope of the increase and risk factors for infection, evaluate health facilities' capacity to manage MDR-TB, and recommend evidence-based control measures. METHODS We defined an MDR-TB case-patient as a TB patient attending Arua Regional Referral Hospital (ARRH) during 2013-2017 with a sputum sample yielding Mycobacterium tuberculosis resistant to at least rifampicin and isoniazid, confirmed by an approved drug susceptibility test. We reviewed clinical records from ARRH and compared the number of MDR-TB cases during January-August 2017 with the same months in 2013-2016. To identify risk factors specific for MDR-TB among cases with secondary infection, we conducted a case-control study using persons with drug-susceptible TB matched by sub-county of residence as controls. We observed infection prevention and control practices in health facilities and community, and assessed health facilities' capacity to manage TB. RESULTS We identified 33 patients with MDR-TB, of whom 30 were secondary TB infection cases. The number of cases during January-August 2017 was 10, compared with 3-4 cases in January-August from 2013 to 2016 (p = 0.02). Men were more affected than women (6.5 vs 1.6/100,000, p < 0.01), as were cases ≥18 years old compared to those < 18 years (8.7 vs 0.21/100,000, p < 0.01). In the case-control study, poor adherence to first-line anti-TB treatment (aOR = 9.2, 95% CI: 2.3-37) and initiating treatment > 15 months from symptom onset (aOR = 11, 95% CI: 1.5-87) were associated with MDR-TB. All ten facilities assessed reported stockouts of TB commodities. All 15 ambulatory MDR-TB patients we observed were not wearing masks given to them to minimize community infection. The MDR-TB ward at ARRH capacity was 4 patients but there were 11 patients. CONCLUSION The number of cases during January-August in 2017 was significantly higher than during the same months in 2013-2016. Poor adherence to TB drugs and delayed treatment initiation were associated with MDR-TB infection. We recommended strengthening directly-observed treatment strategy, increasing access to treatment services, and increasing the number of beds in the MDR-TB ward at ARRH.
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Affiliation(s)
| | - Doreen Birungi
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | | | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Stavia Turyahabwe
- National Tuberculosis and Leprosy Program, Ministry of Health, Kampala, Uganda
| | - Alex R. Ario
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Bao-Ping Zhu
- US Centers for Disease Control and Prevention, Kampala, Uganda
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA USA
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Hameed S, Ahmad SR, Rahman MAU, Nazir H, Ullah I. Drug resistance profile of Mycobacterium tuberculosis and predictors associated with the development of drug resistance. J Glob Antimicrob Resist 2019; 18:155-159. [PMID: 30910744 DOI: 10.1016/j.jgar.2019.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/07/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES Drug-resistant tuberculosis (DR-TB) is a major challenge to national TB control programmes in developing countries. In the Pakistan province of Punjab, the extent and development of DR-TB is not well known. The current study was therefore conducted to assess the incidence and predictors of DR-TB in Punjab Province. METHODS Drug susceptibility testing was performed for 863 confirmed culture-positive Mycobacterium tuberculosis isolates using the proportion method. Patients were enrolled in the Programmatic Management of Drug-Resistant TB Unit of Gulab Devi Chest Hospital (Lahore, Pakistan) from August 2011 to September 2013. Data analysis was performed using IBS SPSS Statistics v.20. Multivariate logistic regression analysis was performed to assess risk factors for DR-TB. RESULTS The rate of resistance to at least one drug (i.e. DR-TB) was 35.0% (302/863) and the rate of multidrug-resistant TB (MDR-TB) was 30.0% (259/863). Among DR-TB cases, the number of females was relatively higher (167/302; 55.3%) compared with males. The majority of DR-TB patients resided in a rural area (229/302; 75.8%). Significant predictors of DR-TB were age 18-45 years, previous TB treatment, rural residence, being a housewife, being married, duration of sickness >1year and unemployment. CONCLUSION The problem of DR-TB in Pakistan is significant. The strongest risk factors were young age and previous anti-TB treatment. Being married, being a housewife, rural residence and unemployment were also risk factors, culminating in an urgent need for effective control, early diagnosis and treatment policies for DR-TB.
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Affiliation(s)
- Salma Hameed
- College of Earth and Environmental Sciences, University of the Punjab, Quaid-i-Azam Campus, Lahore, Pakistan.
| | - Sajid Rashid Ahmad
- College of Earth and Environmental Sciences, University of the Punjab, Quaid-i-Azam Campus, Lahore, Pakistan
| | | | - Humera Nazir
- Institute of Pure and Applied Biology, Bahauddin Zakariya University, Multan, Pakistan
| | - Irfan Ullah
- Gomal Centre of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan; Programmatic Management of Drug-Resistant TB Unit, TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan.
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Ullah I, Ahmad W, Shah AA, Shahzada A, Tahir Z, Qazi O, Hasan F, Ayub N, Badar M, Butt ZA, Basit S. Detection of rifampicin resistance of Mycobacterium tuberculosis using multiplex allele specific polymerase chain reaction (MAS-PCR) in Pakistan. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2019; 71:42-46. [PMID: 30890494 DOI: 10.1016/j.meegid.2019.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 02/10/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
Drug resistance in tuberculosis (TB) is a major public health challenge in developing countries such as Pakistan. Multiplex allele specific polymerase chain reaction (MAS-PCR) is a DNA amplification method that could contribute to rapid detection and control of drug resistant tuberculosis (DR-TB) in Pakistan. The purpose of this study was to test the utility of MAS-PCR to detect resistance in Pakistan. Drug susceptibility testing (DST) was used to identify rifampicin resistant and susceptible clinical isolates from TB cases in Pakistan. MAS-PCR was used to detect the most frequent mutations in the gene rpoB among 213 resistant and 37 susceptible isolates. Among 213 clinical isolates, MAS-PCR identified mutation D435Y (Asp435Tyr) in 24 (11.3%) cases, H445Y (His445Tyr) in 14 (6.6%), S450L (Ser450Leu) in 124 (58.2%) and S450W (Ser450Trp) in 18 (8.4%) cases. MAS-PCR did not detect known mutations in 33 (15.5%) cases. Among 12 cases, a novel mutation at codon 434 (Met434Ile) and a common variant at codon 435 (Asp435Tyr) was detected in rpoB gene which is indicative of double mutation. In 4 isolates, a novel mutation at codon 432 (Gln432Pro) was identified. In an additional 4 isolates, mutations Met434Val and His445Asn were identified. Moreover, a mutation in rpoB (Leu452Pro) was found in 5 isolates. DNA sequencing confirmed the absence of mutations in rpoB in the 8 remaining isolates. MAS-PCR had 88.3% sensitivity and 100% specificity using DST as the reference, which suggested that this method could be implemented as an initial marker for screening of multi-drug resistant tuberculosis (MDR-TB) in Pakistan.
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Affiliation(s)
- Irfan Ullah
- Gomal Centre of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan; Programmatic Management of Drug resistant TB Unit, TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan.
| | - Waqas Ahmad
- Department of Mathematic, University of Science and Technology, Bannu, Khyber Pakhtunkhwa, Pakistan
| | - Aamer Ali Shah
- Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Amir Shahzada
- Nutrition Division, National Institute of Health, Islamabad, Pakistan
| | - Zarfishan Tahir
- Department of Bacteriology, Institute of Public Health, Jail Road, Lahore, Pakistan
| | - Obaidullah Qazi
- Department of Bacteriology, Institute of Public Health, Jail Road, Lahore, Pakistan
| | - Fariha Hasan
- Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Najma Ayub
- Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Muhammad Badar
- Gomal Centre of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan
| | - Zahid Ahmad Butt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sulman Basit
- Center for genetics and inherited diseases, Taibah University Almadinah Almunawwarrah, Saudi Arabia
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Javed H, Bakuła Z, Pleń M, Hashmi HJ, Tahir Z, Jamil N, Jagielski T. Evaluation of Genotype MTBDR plus and MTBDR sl Assays for Rapid Detection of Drug Resistance in Extensively Drug-Resistant Mycobacterium tuberculosis Isolates in Pakistan. Front Microbiol 2018; 9:2265. [PMID: 30319577 PMCID: PMC6169422 DOI: 10.3389/fmicb.2018.02265] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 09/05/2018] [Indexed: 11/13/2022] Open
Abstract
Pakistan ranks 5th among the world's highest tuberculosis (TB) burden countries alongside the 6th among countries with the highest burden of drug-resistant TB, including multi-drug resistant (MDR)-TB. Methods for rapid and reliable drug susceptibility testing (DST) are prerequisite for the prompt institution of effective anti-TB treatment. The aim of this study was to evaluate the efficiency of Genotype MTBDRplus and MTBDRsl assays for the detection of MDR and (pre-) extensively drug-resistant (XDR-TB) isolates in Pakistan. The study included 47 pre-XDR and 6 XDR-TB isolates, recovered from 53 patients from Pakistan. Conventional DST was performed using the standard 1% proportion method on the Löwenstein-Jensen medium. For molecular determination of drug resistance, GenoType MTBDRplus and GenoType MTBDRsl assays (Hain Lifescience, Germany) were used. To evaluate discrepancies between conventional and molecular DST results, mutation profiling was performed by amplifying and sequencing seven genetic loci, i.e., katG, inhA, and mabA-inhA promoter, rpoB, gyrA, embB, rrs. The sensitivity of Genotype MTBDRplus was 71.7% for isoniazid (INH) and 79.2% for rifampicin (RIF). Sequence analysis revealed non-synonymous mutations in 93.3 and 27.3% of isolates phenotypically resistant to INH and RIF, respectively, albeit susceptible when tested by GenoType MTBDRplus. GenoType MTBDRsl had a sensitivity of 73.6, 64.7, 20, 25, and 100% for the detection of fluoroquinolones, ethambutol, kanamycin, amikacin, and capreomycin resistance, respectively. Upon sequencing, mutations were detected in 20, 77.8%, and all isolates phenotypically resistant to aminoglycosides, ethambutol, and fluoroquinolones, respectively, yet declared as susceptible with GenoType MTBDRsl. Low sensitivities seriously impede the large-scale application of the Genotype MTBDRplus and MTBDRsl assays. Unless further optimized, the currently available line-probe assays should rather be auxiliary to the conventional, phenotype-based methods in the detection of MDR- and XDR-TB in Pakistan.
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Affiliation(s)
- Hasnain Javed
- Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
| | - Zofia Bakuła
- Department of Applied Microbiology, Faculty of Biology, Institute of Microbiology, University of Warsaw, Warsaw, Poland
| | - Małgorzata Pleń
- Department of Applied Microbiology, Faculty of Biology, Institute of Microbiology, University of Warsaw, Warsaw, Poland
| | - Hafiza Jawairia Hashmi
- Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
| | | | - Nazia Jamil
- Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
| | - Tomasz Jagielski
- Department of Applied Microbiology, Faculty of Biology, Institute of Microbiology, University of Warsaw, Warsaw, Poland
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Sun ET, Xia D, Li BH, Ma J, Dong YY, Ding SS, Chen BF, Wen YF. Association of Immune Factors with Drug-Resistant Tuberculosis: A Case-Control Study. Med Sci Monit 2017; 23:5330-5336. [PMID: 29118314 PMCID: PMC5691569 DOI: 10.12659/msm.904309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Presently, studies of factors associated with drug-resistant tuberculosis (TB) focus on patients’ socio-demographic characteristics and living habits, to the exclusion of biochemical indicators, especially immune factors. This study was carried out to determine whether immune factors are associated with drug-resistant TB. Material/Methods A total of 227 drug-resistant pulmonary TB patients and 225 drug-susceptible pulmonary TB patients were enrolled in this study. Information on socio-demographic characteristics and biochemical indicators were obtained through their clinical records. Non-conditional logistic regression was used to analyze the association of these indicators with drug-resistant TB. Results There were significant differences in re-treatment, marital status, alanine aminotransferase (ALT), blood uric acid (BUA), carcino-embryonic antigen (CEA), T-spot, and CD3 and CD4 counts between the 2 groups. In multivariable analysis, re-treatment [Odds Ratio (OR)=5.290, 95% Confidence Interval [CI]=2.652–10.551); CD3 (OR=1.034, 95% CI=1.001–1.068); CD4 (OR=1.035, 95% CI =1.001–1.070) and IgM (OR=1.845, 95% CI=1.153–2.952) were associated with drug-resistant TB. Conclusions These results suggest the need for greater attention to re-treatment cases and immune function when treating drug-resistant TB.
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Affiliation(s)
- En-Tao Sun
- School of Public Health, Wannan Medical College, Wuhu, Anhui, China (mainland)
| | - Dan Xia
- School of Public Health, Wannan Medical College, Wuhu, Anhui, China (mainland)
| | - Ben-He Li
- School of Public Health, Wannan Medical College, Wuhu, Anhui, China (mainland)
| | - Jun Ma
- School of Public Health, Wannan Medical College, Wuhu, Anhui, China (mainland)
| | - Yuan-Yuan Dong
- School of Public Health, Wannan Medical College, Wuhu, Anhui, China (mainland)
| | - Shu-Shu Ding
- School of Public Health, Wannan Medical College, Wuhu, Anhui, China (mainland)
| | - Bai-Feng Chen
- School of Public Health, Wannan Medical College, Wuhu, Anhui, China (mainland)
| | - Yu-Feng Wen
- School of Public Health, Wannan Medical College, Wuhu, Anhui, China (mainland)
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Predictors of poor treatment outcomes in multidrug-resistant tuberculosis patients: a retrospective cohort study. Clin Microbiol Infect 2017; 24:612-617. [PMID: 28970158 DOI: 10.1016/j.cmi.2017.09.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 09/05/2017] [Accepted: 09/11/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We aimed to determine the characteristics, treatment outcomes and risk factors for poor treatment outcomes among multidrug-resistant (MDR) tuberculosis (TB) patients in Khyber Pakhtunkhwa province, Pakistan. METHODS A retrospective cohort study including all patients with MDR-TB who sought care at the MDR-TB unit in Peshawar was conducted between January 2012 and April 2014. Patients were followed until an outcome of TB treatment was recorded as successful (cured or completed) or unsuccessful. Binary logistic regression was used to identify predictors of poor outcome, i.e. unsuccessful treatment outcomes. RESULTS Overall, 535 patients were included. The proportion of female subjects was relatively higher (n = 300, 56.1%) than male subjects. The mean (standard deviation) age of patients was 30.37 (14.09) years. Of 535 patients for whom treatment outcomes were available, 402 (75.1%) were cured, 4 (0.7%) completed therapy, 34 (6.4%) had disease that failed to respond to therapy, 93 (17.4%) died and two (0.4%) defaulted; in total, 129 (24.1%) had an unsuccessful outcome. We found three significant predictors of unsuccessful treatment during multivariate logistic regression: being married (odds ratio (OR) = 2.17, 95% confidence interval (CI) 1.01, 4.66), resistance to second-line drugs (OR = 2.61, 95% CI 1.61, 4.21) and presence of extensively drug-resistant TB (OR = 7.82, 95% CI 2.90, 21.07). CONCLUSIONS Approximately 75% of the treatment success rate set by the Global Plan to Stop TB was achieved. Resistance to second-line drugs and presence of extensively drug-resistant TB are the main risk factors for poor treatment outcomes.
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Smear Positive Pulmonary Tuberculosis (TB) Patients Suspected to Have Drug Resistant TB in Programmatic Management of Drug Resistant TB Unit in Khyber Pakhtunkhwa, Pakistan. Jundishapur J Microbiol 2017. [DOI: 10.5812/jjm.14492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Jimma W, Ghazisaeedi M, Shahmoradi L, Abdurahman AA, Kalhori SRN, Nasehi M, Yazdi S, Safdari R. Prevalence of and risk factors for multidrug-resistant tuberculosis in Iran and its neighboring countries: systematic review and meta-analysis. Rev Soc Bras Med Trop 2017; 50:287-295. [PMID: 28700044 DOI: 10.1590/0037-8682-0002-2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/18/2017] [Indexed: 11/21/2022] Open
Abstract
Tuberculosis, in particular drug-resistant tuberculosis, is of global concern due to the high mortality and morbidity associated with it annually. The aim of this study was to determine the prevalence of and the risk factors for multidrug-resistant tuberculosis in Iran and its neighboring countries. Four databases (PubMed, BioMed Central, EMBASE, and Web of Science) were searched using key terms. Nineteen eligible articles were identified, of which 12 and seven were used for quantitative and qualitative analysis, respectively. The overall pooled estimate of the prevalence of multidrug-resistant tuberculosis, including both new and previously treated tuberculosis cases, in Iran, Iraq, Turkey and Pakistan was 16% (95% confidence interval [CI] 11-20). The patients with a previous tuberculosis treatment history (odds ratio [OR] = 6.45; 95% CI 5.12-7.79), those aged <45 years (OR = 1.57; 95% CI 1.12-2.03), and those who were males (OR = 1.83; 95% CI 1.19-2.48) had an increased pool risk of developing multidrug-resistant tuberculosis. The forest plot revealed that the pooled odds for the development of multidrug- resistant tuberculosis were 2.01 (95% CI 1.65-2.36). Poor adherence to treatment was one of the predictors of unsuccessful treatment outcomes. Multidrug-resistant tuberculosis is a great concern for public health programs in many countries globally, including those included in this review. The risk factors for the development of multidrug-resistant tuberculosis, specifically a previous tuberculosis treatment history, should be targeted through the implementation of specialized interventions.
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Affiliation(s)
- Worku Jimma
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, International Campus, Tehran, Iran.,Department of Information Science, College of Natural Sciences, Jimma University, Ethiopia.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghazisaeedi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Shahmoradi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmed Abdulahi Abdurahman
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, International Campus, Tehran, Iran
| | - Sharareh Rostam Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahshid Nasehi
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sharifi Yazdi
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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ABCB1 gene polymorphism associated with clinical factors can predict drug-resistant tuberculosis. Clin Sci (Lond) 2017; 131:1831-1840. [PMID: 28572401 DOI: 10.1042/cs20170277] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/30/2017] [Accepted: 06/01/2017] [Indexed: 12/18/2022]
Abstract
Polymorphism in the ABCB1 gene encoding P-glycoprotein, a transmembrane drug efflux pump, contributes to drug resistance and has been widely studied. However, their association with rifampicin and ethambutol resistance in tuberculosis (TB) patients is still unclear. Genotype/allele/haplotype frequencies in c.1236C > T (rs1128503), c.2677G > T/A (rs2032582), and c.3435C > T (rs1045642) were obtained from 218 patients. Of these, 80 patients with rifampicin and/or ethambutol resistance were selected as the case group and 138 patients were selected for the control group through the results of their culture and drug-sensitive tests. Patients aged <18 years and HIV-positive serologic tests were excluded. ABCB1 polymorphisms were determined using a PCR direct-sequencing approach, and restriction fragment length polymorphism (RFLP). A nomogram was constructed to simulate a combined prediction of the probability of anti-TB drug resistance, with factors including genotype c.1236C > T (rs1128503) (P=0.02), clinical form (P=0.03), previous treatment (P=0.01), and skin color (P=0.03), contributing up to 90% chance of developing anti-TB drug resistance. Considering genotype analyses, CT (rs1128503) demonstrated an increased chance of anti-TB drug resistance (odds ratio (OR): 2.34, P=0.02), while the analyses for ethambutol resistance revealed an association with a rare A allele (rs2032582) (OR: 12.91, P=0.01), the haplotype TTC (OR: 5.83, P=0.05), and any haplotype containing the rare A allele (OR: 7.17, P=0.04). ABCB1 gene polymorphisms in association with others risk factors contribute to anti-TB drug resistance, mainly ethambutol. The use of the nomogram described in the present study could contribute to clinical decision-making prior to starting TB treatment.
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Ullah I, Javaid A, Masud H, Ali M, Basit A, Ahmad W, Younis F, Yasmin R, Khan A, Jabbar A, Husain M, Butt ZA. Rapid detection of Mycobacterium tuberculosis and rifampicin resistance in extrapulmonary tuberculosis and sputum smear-negative pulmonary suspects using Xpert MTB/RIF. J Med Microbiol 2017; 66:412-418. [PMID: 28425873 DOI: 10.1099/jmm.0.000449] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a serious public health problem in developing countries such as Pakistan. Rapid diagnosis of TB and detection of drug resistance are very important for timely and appropriate management of multidrug-resistant TB (MDR-TB). OBJECTIVE The purpose of this study was to determine the diagnostic efficacy of the Xpert MTB/RIF assay for rapid diagnosis of TB and detection of rifampicin (RIF) resistance in extrapulmonary and smear-negative pulmonary TB suspects. METHODS A total of 98 bronchoalveolar lavage fluid (BALF) and 168 extrapulmonary specimens were processed by Xpert MTB/RIF. Culture results are considered as the gold standard for diagnosis of TB, and drug susceptibility testing for detection of RIF resistance. Diagnostic efficacy was measured in terms of sensitivity, specificity and positive and negative predictive values. RESULTS The Xpert MTB/RIF assay detected 40 (40.8 %) of 98 BALF of presumptive pulmonary TB and 60 (35.7 %) of 168 extrapulmonary specimens. Sensitivity and specificity of the Xpert MTB/RIF assay for detection of TB was 86 and 88.4 %, respectively. The positive predictive value was 71.5 % while negative predictive value was 95.1 %. CONCLUSION The Xpert MTB/RIF assay is a rapid and simple technique with high sensitivity and specificity for diagnosing TB and detecting drug resistance in extrapulmonary and smear-negative TB cases.
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Affiliation(s)
- Irfan Ullah
- Programmatic Management of Drug resistant TB Unit, TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan.,Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Arshad Javaid
- Programmatic Management of Drug resistant TB Pulmonology, Lady Reading Hospital, Peshawar, Pakistan
| | - Haleema Masud
- Al-Shifa School of Public Health, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Mazhar Ali
- Programmatic Management of Drug resistant TB Pulmonology, Lady Reading Hospital, Peshawar, Pakistan
| | - Anila Basit
- Programmatic Management of Drug resistant TB Pulmonology, Lady Reading Hospital, Peshawar, Pakistan
| | - Waqas Ahmad
- Department of Mathematics, University of Science and Technology, Bannu, Pakistan
| | - Faisal Younis
- Programmatic Management of Drug resistant TB Unit, TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan
| | - Rehana Yasmin
- Department of Animal Sciences, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Afsar Khan
- Programmatic Management of Drug resistant TB Pulmonology, Lady Reading Hospital, Peshawar, Pakistan
| | - Abdul Jabbar
- Department of Medical lab Technology, University of Haripur, Haripur, Pakistan
| | - Masroor Husain
- Department of Biotechnology, University of Science and Technology, Bannu, Pakistan
| | - Zahid Ahmad Butt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Spatial patterns of multidrug resistant tuberculosis and relationships to socio-economic, demographic and household factors in northwest Ethiopia. PLoS One 2017; 12:e0171800. [PMID: 28182726 PMCID: PMC5300134 DOI: 10.1371/journal.pone.0171800] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/26/2017] [Indexed: 11/19/2022] Open
Abstract
Background Understanding the geographical distribution of multidrug-resistant tuberculosis (MDR-TB) in high TB burden countries such as Ethiopia is crucial for effective control of TB epidemics in these countries, and thus globally. We present the first spatial analysis of multidrug resistant tuberculosis, and its relationship to socio-economic, demographic and household factors in northwest Ethiopia. Methods An ecological study was conducted using data on patients diagnosed with MDR-TB at the University of Gondar Hospital MDR-TB treatment centre, for the period 2010 to 2015. District level population data were extracted from the Ethiopia National and Regional Census Report. Spatial autocorrelation was explored using Moran’s I statistic, Local Indicators of Spatial Association (LISA), and the Getis-Ord statistics. A multivariate Poisson regression model was developed with a conditional autoregressive (CAR) prior structure, and with posterior parameters estimated using a Bayesian Markov chain Monte Carlo (MCMC) simulation approach with Gibbs sampling, in WinBUGS. Results A total of 264 MDR-TB patients were included in the analysis. The overall crude incidence rate of MDR-TB for the six-year period was 3.0 cases per 100,000 population. The highest incidence rate was observed in Metema (21 cases per 100,000 population) and Humera (18 cases per 100,000 population) districts; whereas nine districts had zero cases. Spatial clustering of MDR-TB was observed in districts located in the Ethiopia-Sudan and Ethiopia-Eritrea border regions, where large numbers of seasonal migrants live. Spatial clustering of MDR-TB was positively associated with urbanization (RR: 1.02; 95%CI: 1.01, 1.04) and the percentage of men (RR: 1.58; 95% CI: 1.26, 1.99) in the districts; after accounting for these factors there was no residual spatial clustering. Conclusion Spatial clustering of MDR-TB, fully explained by demographic factors (urbanization and percent male), was detected in the border regions of northwest Ethiopia, in locations where seasonal migrants live and work. Cross-border initiatives including options for mobile TB treatment and follow up are important for the effective control of MDR-TB in the region.
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Rifampicin resistance mutations in the 81 bp RRDR of rpoB gene in Mycobacterium tuberculosis clinical isolates using Xpert MTB/RIF in Khyber Pakhtunkhwa, Pakistan: a retrospective study. BMC Infect Dis 2016; 16:413. [PMID: 27519406 PMCID: PMC4983047 DOI: 10.1186/s12879-016-1745-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 08/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multi-drug resistant tuberculosis (MDR-TB) is a major public health problem especially in developing countries. World Health Organization (WHO) recommends use of Xpert MTB/RIF assay to simultaneously detecting Mycobacterium tuberculosis (MTB) and rifampicin (RIF) resistance. The primary objective of this study was to determine the frequency of MDR-TB in patients suspected to have drug resistance in Khyber Pakhtunkhwa. The frequency of probes for various rpoB gene mutations using Xpert MTB/RIF assay within 81 bp RRDR (Rifampicin Resistance Determining Region) was the secondary objective. METHODS A total of 2391 specimens, received at Programmatic Management of Drug Resistant TB (PMDT) Unit, Lady Reading Hospital (LRH) Peshawar, Pakistan, between October 2011 and December 2014, were analyzed by Xpert MTB/RIF test. MTB positive with rifampicin resistance were further analyzed to first line anti-mycobacterial drug susceptibility testing (DST) using middle brook 7H10 medium. The data was analyzed using statistical software; SPSS version 18. RESULTS Out of 2391 specimens, 1408 (59 %) were found positive for MTB and among them, 408 (29 %) showed rifampicin-resistance with four different rpoB gene mutations within 81 bp RRDR. The frequency of various probes among RIF-resistant isolates was observed as: probe E, in 314 out of 408 isolates; B, 44 out of 408; A, 5 out of 408; D, 34 out of 408; and probe C was observed among 6 out of 408 RIF-resistant isolates. The probe A&B and E&D mutation combination was found in only 1 isolate in each case, while B&D mutation combination was detected among 3 out of 408 RIF-resistant isolates. CONCLUSIONS Hence, it is concluded from our study on a selected population, 29 % of patients had MDR-TB. Probe E related mutations (also known as codon 531and 533) were the most common rpoB genetic mutation [314 (77 %)], acknowledged by Xpert MTB/RIF assay. Least mutation was detected within the sequence 511 (1.2 %).
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