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Salmanzadeh S, Karamian M, Alavi SM, Nashibi R. Evaluation of the frequency of resistance to 2 drugs (Isoniazid and Rifampin) by molecular investigation and it's risk factors in new cases of smear positive pulmonary tuberculosis in health centers under the cover of Jundishapur University of Medical Sciences in 2017. J Family Med Prim Care 2020; 9:1958-1962. [PMID: 32670947 PMCID: PMC7346914 DOI: 10.4103/jfmpc.jfmpc_983_19] [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: 09/06/2019] [Revised: 11/20/2019] [Accepted: 12/16/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction: Despite the great efforts to control tuberculosis (TB), the disease is still one of the major health challenges throughout the world. The basic treatment for TB is drug therapy. Currently, the main anti-tuberculosis drugs with major use in the treatment and control of the disease are isoniazid, rifampin, pyrazinamide, ethambutol, and streptomycin. One of the serious crises in controlling TB epidemic is diagnosis and treatment of patients with Multidrug Resistant Tuberculosis (MDR-TB MDR). The purpose of the study was to examine and evaluate the resistance of mycobacterium TB strains isolated from specimens of newly diagnosed smear positive pulmonary TB to isoniazid and rifampin using molecular methods and their risk factors. Methods: Sputum samples of newly diagnosed smear positive pulmonary TB patients were prepared, collected, and sent to Reference Laboratory in Ahvaz. DNA of mycobacterium tuberculosis was prepared from the samples using Qiagen kit according to the instructions of the manufacturing company. Isoniazid resistance was evaluated using specific primers for inhA and KatG genes. Rifampin resistance was evaluated using MAS-PCR method with three specific alleles of rpobB codons and codons 516, 526 and 531. Results: Mycobacterium tuberculosis resistance to Isoniazid was 7.3%, to Rifampin 5.5% and to both drugs 1.8%. In our study, there were no association between drug resistance and gender, age, prison history, smoking, drug use, underlying disease, occupation, and HIV. Conclusion: According our findings that include prevalence of 7.3% Isoniazide resistance, 5.5% Rifampin resistance and 1.8% to both drugs, evaluating all newly diagnosed patients for resistance to standard anti-tuberculosis treatment seems rational.
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Affiliation(s)
- Shokrollah Salmanzadeh
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Masoumeh Karamian
- Infectious Diseases and Tropical Medicine, Ahvaz Jundishapur University of Medical Sciences, Medical School, Razi Teaching Hospital, Ahvaz, Iran
| | - Seyed Mohammad Alavi
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Roohangiz Nashibi
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Floridia M, Ciccacci F, Andreotti M, Hassane A, Sidumo Z, Magid NA, Sotomane H, David M, Mutemba E, Cebola J, Mugunhe RJ, Riccardi F, Marazzi MC, Giuliano M, Palombi L, Mancinelli S. Tuberculosis Case Finding With Combined Rapid Point-of-Care Assays (Xpert MTB/RIF and Determine TB LAM) in HIV-Positive Individuals Starting Antiretroviral Therapy in Mozambique. Clin Infect Dis 2018; 65:1878-1883. [PMID: 29020319 DOI: 10.1093/cid/cix641] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/20/2017] [Indexed: 12/12/2022] Open
Abstract
Background Tuberculosis is a major health concern in several countries, and effective diagnostic algorithms for use in human immunodeficiency virus (HIV)-positive patients are urgently needed. Methods At prescription of antiretroviral therapy, all patients in 3 Mozambican health centers were screened for tuberculosis, with a combined approach: World Health Organization (WHO) 4-symptom screening (fever, cough, night sweats, and weight loss), a rapid test detecting mycobacterial lipoarabinomannan in urine (Determine TB LAM), and a molecular assay performed on a sputum sample (Xpert MTB/RIF; repeated if first result was negative). Patients with positive LAM or Xpert MTB/RIF results were referred for tuberculosis treatment. Results Among 972 patients with a complete diagnostic algorithm (58.5% female; median CD4 cell count, 278/μL; WHO HIV stage I, 66.8%), 98 (10.1%) tested positive with Xpert (90, 9.3%) or LAM (34, 3.5%) assays. Compared with a single-test Xpert strategy, dual Xpert tests improved case finding by 21.6%, LAM testing alone improved it by 13.5%, and dual Xpert tests plus LAM testing improved it by 32.4%. Rifampicin resistance in Xpert-positive patients was infrequent (2.5%). Among patients with positive results, 22 of 98 (22.4%) had no symptoms at WHO 4-symptom screening. Patients with tuberculosis diagnosed had significantly lower CD4 cell counts and hemoglobin levels, more advanced WHO stage, and higher HIV RNA levels. Fifteen (15.3%) did not start tuberculosis treatment, mostly owing to rapidly deteriorating clinical conditions or logistical constraints. The median interval between start of the diagnostic algorithm and start of tuberculosis treatment was 7 days. Conclusions The prevalence of tuberculosis among Mozambican HIV-positive patients starting antiretroviral therapy was 10%, with limited rifampicin resistance. Use of combined point-of-care tests increased case finding, with a short time to treatment. Interventions are needed to remove logistical barriers and prevent presentation in very advanced HIV/tuberculosis disease.
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Affiliation(s)
- Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità
| | | | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità
| | | | - Zita Sidumo
- DREAM Program, Community of S. Egidio, Maputo
| | | | | | | | - Elsa Mutemba
- DREAM Program, Community of S. Egidio, Beira, Mozambique
| | - Junia Cebola
- DREAM Program, Community of S. Egidio, Beira, Mozambique
| | | | - Fabio Riccardi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata
| | | | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità
| | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata
| | - Sandro Mancinelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata
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Baltazar CS, Taibo C, Sacarlal J, Gujral L, Salomão C, Doyle T. Mozambique field epidemiology and laboratory training program: a pathway for strengthening human resources in applied epidemiology. Pan Afr Med J 2017; 27:233. [PMID: 28979635 PMCID: PMC5622808 DOI: 10.11604/pamj.2017.27.233.13183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 07/12/2017] [Indexed: 01/09/2023] Open
Abstract
Introduction In the last decades, Mozambique has been undergoing demographic, epidemiological, economic and social transitions, which have all had a notable impact on the National Health System. New challenges have emerged, causing a need to expand the preparation and response to emerging disease threats and public health emergencies. Methods We describe the structure and function of the Mozambique Field Epidemiology Training Program (MZ-FELTP) and the main outputs achieved during the first 6 years of program implementation (consisting of 3 cohorts). We also outline the contribution of the program to the National Health System and assess the retention of the graduates. Results The MZ-FELTP is a post-graduate in-service training program, based on the acquisition of skills, within two tracks: applied epidemiology and laboratory management. The program was established in 2010, with the objective of strengthening capacity in applied epidemiology and laboratory management, so that events of public health importance can be detected and investigated in a timely and effective manner. The program is in its seventh year, having successfully trained 36 health professionals in the advanced course. During the first six years of the program, more than 40 outbreaks were investigated, 37 surveillance system evaluations were conducted and 39 descriptive data analyses were performed. Surveillance activities were implemented for mass events and emergency situations. In addition, more than 100 oral and poster presentations were given by trainees at national and international conferences. Conclusion The MZ-FELTP has helped provide the Ministry of Health with the human and technical resources and operational capacity, to rapidly and effectively respond to major public health challenges in the country. The continuous involvement of key stakeholders is necessary for the continuation, expansion and ongoing sustainability of the program.
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Affiliation(s)
| | - Cátia Taibo
- Faculty of Medicine, Eduardo Mondlane University
| | | | - Lorna Gujral
- National Public Health Directorate, Ministry of Health, Mozambique
| | | | - Timothy Doyle
- Centers for Disease Control and Prevention, Mozambique
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Namburete EI, Tivane I, Lisboa M, Passeri M, Pocente R, Ferro JJ, Harrison LH, Bollela VR. Drug-resistant tuberculosis in Central Mozambique: the role of a rapid genotypic susceptibility testing. BMC Infect Dis 2016; 16:423. [PMID: 27534745 PMCID: PMC4989517 DOI: 10.1186/s12879-016-1766-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 08/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Genotypic molecular testing may be very helpful for tuberculosis (TB) drug-resistance surveillance and for treatment guidance in low resource settings. METHODS Descriptive analysis of M. tuberculosis isolates from Beira Central Hospital, Mozambique, during 2014-2015. Genotype MTBDRplus and MTBDRsl were used and patient medical records reviewed. To explore genotypic susceptibility profile of Mycobacterium tuberculosis, to first and second line drugs (SLD) in Beira Mozambique. RESULTS Of 155 isolates, 16.1 % (25) were multidrug resistant (MDR), 8.4 % (13) isoniazid-monoresistant and 1.3 % (2) rifampicin-monoresistant. Among MDR-TB, 22.2 % showed primary and 77.8 % represented acquired resistance. The majority of patients with drug resistance had a history of previous TB treatment. Among 125 isolates tested for ethambutol and SLD, 7.2 % (9) were resistant to ethambutol, 4.8 % (6) to fluoroquinolones and 0.8 % (1) to ethambutol and fluoroquinolones. Resistance to injectable SLD was not detected. CONCLUSIONS As far as we know this is the first report of a genotypic testing used to provide information about SLD resistance in Mozambique, where phenotypic susceptibility testing is usually unavailable. Extensively drug resistant TB was not detected in this isolates from Beira Mozambique.
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Affiliation(s)
- Evangelina Inácio Namburete
- School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.,Faculdade de Ciências de Saúde da Universidade Católica de Moçambique, Beira, Mozambique
| | - Inês Tivane
- Laboratório de Referencia de tuberculose, Hospital Central da Beira, Moçambique, Beira, Mozambique
| | - Miguelhete Lisboa
- Laboratório de Referencia de tuberculose, Hospital Central da Beira, Moçambique, Beira, Mozambique
| | - Margarida Passeri
- Laboratório de Microbactérias do HCFMRP, USP, Ribeirão Preto, Brasil
| | - Renata Pocente
- Laboratório de Microbactérias do HCFMRP, USP, Ribeirão Preto, Brasil
| | - Josefo Joao Ferro
- Faculdade de Ciências de Saúde da Universidade Católica de Moçambique, Beira, Mozambique
| | - Lee H Harrison
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, USA
| | - Valdes Roberto Bollela
- School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil. .,Internal Medicine Department, Hospital das Clínicas School of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Monte Alegre, 14049-900, Ribeirão Preto, São Paulo, Brazil.
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Yuen CM, Rodriguez CA, Keshavjee S, Becerra MC. Map the gap: missing children with drug-resistant tuberculosis. Public Health Action 2015; 5:45-58. [PMID: 26400601 PMCID: PMC4525371 DOI: 10.5588/pha.14.0100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/08/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The lack of published information about children with multidrug-resistant tuberculosis (MDR-TB) is an obstacle to efforts to advocate for better diagnostics and treatment. OBJECTIVE To describe the lack of recognition in the published literature of MDR-TB and extensively drug-resistant TB (XDR-TB) in children. DESIGN We conducted a systematic search of the literature published in countries that reported any MDR- or XDR-TB case by 2012 to identify MDR- or XDR-TB cases in adults and in children. RESULTS Of 184 countries and territories that reported any case of MDR-TB during 2005-2012, we identified adult MDR-TB cases in the published literature in 143 (78%) countries and pediatric MDR-TB cases in 78 (42%) countries. Of the 92 countries that reported any case of XDR-TB, we identified adult XDR-TB cases in the published literature in 55 (60%) countries and pediatric XDR-TB cases for 9 (10%) countries. CONCLUSION The absence of publications documenting child MDR- and XDR-TB cases in settings where MDR- and XDR-TB in adults have been reported indicates both exclusion of childhood disease from the public discourse on drug-resistant TB and likely underdetection of sick children. Our results highlight a large-scale lack of awareness about children with MDR- and XDR-TB.
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Affiliation(s)
- C. M. Yuen
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - S. Keshavjee
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - M. C. Becerra
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
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