Drug-resistant tuberculosis in a tertiary referral teaching hospital of Korea

Contact investigation in multidrug-resistant tuberculosis: ethical challenges

Contact investigation is an evidence-based intervention of multidrug-resistant tuberculosis (MDR-TB) to protect public health by interrupting the chain of transmission. In pursuit of contact investigation, patients' MDR-TB status has to be disclosed to third parties (to the minimum necessary) for tracing the contacts. Nevertheless, disclosure to third parties often unintentionally leads the MDR-TB patients suffered from social discrimination and stigma. For this reason, patients are less inclined to reveal their MDR-TB status and becomes a significant issue in contact investigation. This issue certainly turns into a negative impact on the public interest. Tension between keeping MDR-TB status confidential and safeguarding public health arises in relation to this issue. Regarding MDR-TB management, patient compliance with treatment and contact investigation are equally important. Patients might fail to comply with anti-TB therapy and be reluctant to seek healthcare due to disclosure concerns. In order to have treatment adherence, MDRTB patients should not live through social discrimination and stigma arising from disclosure and TB team has a duty to support them as a mean of reciprocity. However, implementation of contact investigation as a public health policy can still be challenging even with promising reciprocal support to the patients because MDR-TB patients are living in different contexts and situations. There can be no straight forward settlement but an appropriate justification for each distinct context is needed to strike a balance between individual confidentiality and public interest.

Multidrug-Resistant TB (MDR-TB) and Extensively Drug-Resistant TB (XDR-TB) Among Children: Where We Stand Now

Drug-resistant tuberculosis (DR-TB) has continued to be a global health cataclysm. It is an arduous condition to tackle but is curable with the proper choice of drug and adherence to the drug therapy. WHO has introduced newer drugs with all-oral shorter regimens, but the COVID-19 pandemic has disrupted the achievements and raised the severity. The COVID-19 controlling mechanism is based on social distancing, using face masks, personal protective equipment, medical glove, head shoe cover, face shield, goggles, hand hygiene, and many more. Around the globe, national and international health authorities impose lockdown and movement control orders to ensure social distancing and prevent transmission of COVID-19 infection. Therefore, WHO proposed a TB control program impaired during a pandemic. Children, the most vulnerable group, suffer more from the drug-resistant form and act as the storehouse of future fatal cases. It has dire effects on physical health and hampers their mental health and academic career. Treatment of drug-resistant cases has more success stories in children than adults, but enrollment for treatment has been persistently low in this age group. Despite that, drug-resistant childhood tuberculosis has been neglected, and proper surveillance has not yet been achieved. Insufficient reporting, lack of appropriate screening tools for children, less accessibility to the treatment facility, inadequate awareness, and reduced funding for TB have worsened the situation. All these have resulted in jeopardizing our dream to terminate this deadly condition. So, it is high time to focus on this issue to achieve our Sustainable Development Goals (SDGs), the goal of ending TB by 2030, as planned by WHO. This review explores childhood TB's current position and areas to improve. This review utilized electronic-based data searched through PubMed, Google Scholar, Google Search Engine, Science Direct, and Embase.

Primary multidrug-resistant tuberculosis versus drug-sensitive tuberculosis in non-HIV-infected patients: Comparisons of CT findings

Background

Multidrug-resistant tuberculosis has emerged as a global threat. The aim of this work was to compare the CT findings of primary multidrug-resistant tuberculosis and drug-sensitive tuberculosis in non-AIDS adults.

Material and methods

From January 2012 to February 2016, 89 patients with primary multidrug-resistant tuberculosis were retrospectively reviewed, and 89 consecutive drug sensitive TB patients with no history of anti-tuberculous chemotherapy from January 2014 to November 2014 were enrolled as control group. All patients were seronegative for HIV. The patients’ demographic data and the locations, frequency and patterns of lung lesions on chest CT were compared.

Results

Gender and frequency of diabetes were similar between the two groups. The mean age of primary multidrug-resistant tuberculosis patients was younger than that of drug-sensitive tuberculosis (39.0 vs 47.5, P = 0.005). Lung cavitary nodules or masses were more frequently observed and also showed greater extent in primary multidrug-resistant tuberculosis compared with drug-sensitive tuberculosis. The extent of bronchiectasis was significantly greater in primary multidrug-resistant tuberculosis than in drug-sensitive tuberculosis. Calcification, large nodules and calcified lymph nodes were more frequent in drug-sensitive tuberculosis.

Conclusion

Characteristic chest CT findings may help differentiate between primary multi-drug resistant tuberculosis and drug-sensitive tuberculosis in patients without HIV infection.

Predictors of multidrug resistant tuberculosis among adult patients at Saint Peter Hospital Addis Ababa, Ethiopia

INTRODUCTION

The emergence of multi-drug resistant tuberculosis (MDR-TB) has become a major public health concern that threatens advances made in global TB control efforts. Though the problem is prevalent, it did not receive major attention to generate supportive evidence for the prevention and control of MDR-TB. The aim of this study was to identify predictors of MDR-TB in a national TB referral centre in Ethiopia.

METHODS

An unmatched, case-control study was conducted at St. Peter Hospital to assess risk factors associated with MDR-TB. The study included 103 culture proven, MDR-TB patients referred to the hospital during the study period (cases) and 103 randomly-selected TB patients with confirmed TB who turned negative after treatment (controls). Regressions analyses were used to determine the association of variables.

RESULTS

The mean age among cases and controls was 30.5 (±9.26) and 34.73 (±11.28) years, respectively. The likelihood of having MDR-TB was 20.3 times higher among those who had a any previous history of TB treatment (AOR=20.3 [CI 5.13, 80.58]), 15.7 times higher among those who had TB more than once (AOR=15.7 [CI 4.18, 58.71]) compared those who had once, 6.8 times higher among those who had pulmonary TB (AOR=6.8 [CI 1.16, 40.17]) and 16.1 times higher for those who had experienced treatment with a Category II regimen (AOR=16.1 [CI 2.40, 108.56]). HIV infection was less common among cases than controls.

CONCLUSION

This study concluded that special attention should be given to patients with a history of the following: TB more than once, presence of pulmonary TB, and used a Category II treatment regimen, as these were all determining factors for MDR-TB. Thus, this study urges the development and implementation of well-planned and integrated strategies for MDR-TB control and prevention in Ethiopia.

CT and microbiologic follow-up in primary multidrug-resistant pulmonary tuberculosis

BACKGROUND

Little attention has been paid to the initial and follow-up computed tomography (CT) features in primary multi-drug resistant tuberculosis (pMDR-TB) setting.

PURPOSE

To describe serial CT findings and clinical course of pMDR-TB with antibiotic treatment.

MATERIAL AND METHODS

For the last 10 years, 340 MDR-TB patients were managed in a tertiary referral hospital. Among them, we included 44 (27 men, 17 women; mean age, 40 years; age range, 20-81 years) pMDR-TB patients; 37 treated with chemotherapy only and seven treated with medical therapy plus surgery. CT findings were evaluated regarding tree-in-bud sign, acinar nodule, peribronchial, segmental or lobar consolidation and cavity, and their extent. Sputum negative conversion rates and serial CT scores were assessed. To compare changes in disease extent between initial and follow-up CT studies, paired t-test was performed.

RESULTS

Two most frequent patterns of lung abnormality were tree-in-bud sign (37 of 44, 84.1%) and acinar nodule (41 of 44, 93.2%). Among 37 patients treated with chemotherapy only, 36 showed negative sputum conversion within 3 months after second-line drug commencement, maintained for >12 months. The other seven undergoing surgery during medical treatment showed excellent outcome with negative conversion achieved within one month after surgery and maintained for >12 months. CT scores showed significant decrease on serial CT studies (P < 0.001) in all.

CONCLUSION

In pMDR-TB, two most frequent abnormal CT patterns are tree-in-bud sign and acinar nodule. In 98% of patients, negative sputum conversion is achieved, and CT score also shows decrease in extent after TB chemotherapy.

Mycobacterium tuberculosis resistance pattern against first-line drugs in patients from urban area

OBJECTIVE/BACKGROUND

Tuberculosis (TB) infection is still a major public health burden in Indonesia. TB cases in Indonesia constitute 35% of all the TB cases detected worldwide and the prevalence of TB drug resistance in this country is approximately 3%. The aim of this study was to evaluate the resistance of Mycobacterium tuberculosis to first-line TB drugs among isolates from clinical specimens from a hospital in an urban area.

METHODS

This laboratory-based study was conducted in Tangerang District, Indonesia, from January 2011 to December 2014. Sputum and other clinical specimens were obtained from patients with pulmonary and extrapulmonary TB. The specimens were stained with Ziehl-Neelsen, inoculated on Löwenstein-Jensen media for 6-8 weeks, and tested for sensitivity against first-line TB drugs [isoniazid (INH), rifampicin (RIF), ethambutol (EMB), and streptomycin (SM)].

RESULTS

All TB patients in this study lived in urban areas with male preponderance. Of the 127 M. tuberculosis isolates collected, 22% showed resistance to first-line TB drugs. Among these resistant isolates, 20.5% showed resistance to at least one of the first-line TB drugs and 0.8% showed multidrug resistance (MDR). Resistance to EMB, INH, RIF, and SM was seen in 6.3% 6.3%, 4.7%, and 1.6% of isolates, respectively. Polyresistance to EMB and INH, EMB and RIF, and EMB, INH, and RIF was seen in 0.8% of the isolates, respectively.

CONCLUSION

Our study confirms that drug resistance, including MDR, observed against all first-line TB drugs was a real threat in the management of TB infection in Indonesia. The resistance pattern identified in this study could assist clinicians in providing appropriate treatment regimen to TB patients and improve their clinical outcome.

Poly-resistant Tuberculosis in an HIV-infected Child

Drug-resistant tuberculosis (DR-TB) has been reported in India, but has been rarely documented in children. HIV co-infection has led to resurgence of tuberculosis (TB), making treatment even more difficult due to complex drug interactions. Poly-resistant TB is rare in children, especially in HIV-infected children. We report an HIV-infected child who developed poly-resistant TB (resistance to Streptomycin and Isoniazid) after 3 years of completion of anti-tuberculosis treatment (ATT). His mother had also received ATT 3 years back. We conclude that DR-TB in HIV-infected children should be considered if the child had been treated with ATT in the past or there is contact with adults on second-line ATT therapy.

Multidrug-resistant pulmonary tuberculosis among young Korean soldiers in a communal setting

The goal of this study was to evaluate the prevalence of first-line anti-tuberculosis drug resistance and risk factors associated with multidrug-resistant tuberculosis (MDR TB) among young soldiers in the Korean military, which has a strict tuberculosis control program. All patients with culture-confirmed pulmonary tuberculosis during their service at the Armed Forces Capital Hospital from January 2001 to December 2006 were enrolled in the study. Drug resistant Mycobacterium tuberculosis was isolated from 18 patients (12.2%) and multidrug-resistant M. tuberculosis was isolated from 12 patients (8.1%). Previous treatment of tuberculosis and the presence of a cavity on the patient's chest computed tomography scan were associated with MDR TB; military rank, smoking habits, and positive acid-fast bacilli smears were not associated with MDR TB. In a multiple logistic regression analysis, previous treatment of tuberculosis was a significant independent risk factor for MDR TB (odds ratio 6.12, 95% confidence interval 1.53-24.46). The prevalence of drug resistant tuberculosis among young soldiers in the Korean military was moderately high and the majority of resistant cases were found in patients who had undergone previous treatment of tuberculosis. Based on our results, we suggest that relapsed tuberculosis cases within communal settings should be cautiously managed until the drug susceptibility tests report is completed, even if previous treatment results were satisfactory.

Prevalence of multidrug-resistant pulmonary tuberculosis in counties with different duration of DOTS implementation in rural China

AIMS

This study aimed to describe the prevalence of drug-resistant tuberculosis (TB) among pulmonary TB patients in rural China and to determine the extent of multidrug-resistant TB (MDR-TB) circulating in areas with varied duration of Directly Observed Treatment, Short Course (DOTS) implementation.

METHODS

A cross-sectional study was conducted in two rural counties in eastern China: Deqing with over 10 years' DOTS implementation and Guanyun under its second year of DOTS. The subjects were all culture-positive pulmonary TB patients newly diagnosed or re-treated during 12 months of 2004-2005. The proportion method was used for drug susceptibility testing.

RESULTS

Among the 399 subjects, 283 were new TB cases and 116 were previously treated. The rates of overall resistance (i.e., resistance to at least one drug) in new cases were 50.4% (67) and 63.4% (95), respectively, in Deqing and Guanyun (p = 0.028), and 67.3% (33) and 83.6% (56), respectively, in previously treated cases (p = 0.0410). The rates of MDR-TB in new cases were 3.8% (5) in Deqing and 14.7% (22) in Guanyun (p = 0.0018), and 16.3% (8) and 34.3% (23) in previously treated cases (p = 0.0305).

CONCLUSIONS

Newly diagnosed and previously treated TB patients from the short-term DOTS-covered county were at higher risk for overall drug-resistance TB and MDR-TB. Standardized diagnosis and treatment strategies for drug-resistant TB are urgently needed for effective control of MDR-TB in rural China.

Risk factors for drug resistant tuberculosis in southeast Turkey

SUMMARY

We undertook a cross-sectional survey of 116 patients at Dicle Hospital, Turkey, who had with bacteriologically confirmed tuberculosis (TB). Demographic and clinical features, including age, gender, pulmonary TB history, associated diabetes mellitus, previous TB treatment, residential area and education, were collected from charts. Eighty-four of the strains were found to be susceptible to all drugs. The resistance to one or more drug(s) was found in 32 strains. Multi-drug resistant (MDR) TB was found in 13 strains (11.3% of the total and 40.7% of the drug resistant strains). The resistance to isoniazid was the most frequently seen (25 strains, 21.5%). In the multivariable analysis, only previous TB treatment ( P = 0.000) remained a significant predictor for drug resistance; in MDR, previous TB treatments ( P = 0.002) remained significant in the final model. The patient's educational status was found to be negatively correlated with the risk of MRD-TB ( P = 0.035). Previous TB treatment and low educational status were found to important risk factors for the development of MDR-TB.

Drug resistance rates of Mycobacterium tuberculosis at a private referral center in Korea

The goals of this study were to identify first-line drug resistance in new and previously treated tuberculosis (TB) cases and to determine risk factors for multidrug resistant TB (MDR-TB) at a private referral center in Korea. All patients with culture confirmed pulmonary TB over a 2-yr period between July 2002 and June 2004 were prospectively included in this study. In total, 637 patients were included; 512 (80.4%) were new cases, and 125 (19.6%) were previously treated cases. Resistance to at least one first-line drug was identified in 11.7% of new cases and 41.6% of previously treated cases. MDR-TB was detected in 3.9% of new cases and 27.2% of previously treated cases. The proportion of extensively drug-resistant TB among MDR-TB patients was 16.7% (9/54). Factors associated with MDR-TB included age under 45 yr, previous TB treatment, and the presence of cavitation on chest radiography. Rates of first-line drug resistance are high, particularly in previously treated patients, in the private sector in Korea. This underscores the need for an improved control program, coupled with early diagnosis of MDR-TB, to reduce the spread and development of resistance.

Multidrug-Resistant Tuberculosis Versus Drug-Sensitive Tuberculosis in Human Immunodeficiency Virus-Negative Patients

OBJECTIVES

To compare the computed tomography (CT) features of patients with multidrug-resistant tuberculosis with those of patients with drug-sensitive tuberculosis in a country not associated with the human immunodeficiency virus (HIV) epidemic.

METHODS

The CT images of 47 patients with multidrug-resistant tuberculosis were compared with those of 47 patients with drug-sensitive tuberculosis as a control group. Each multidrug-resistant tuberculosis patient was age (decade) and gender matched to a drug-sensitive tuberculosis patient. All patients were seronegative to HIV. This study evaluated the presence of centrilobular nodules, consolidation, emphysema, bronchiectasis, lung destruction, calcified granuloma, cavitation, pleural effusion, and lymphadenopathy. A statistical comparison was performed by using the Fisher exact test for univariate analysis and a multiple logistic regression method for multivariate analysis.

RESULTS

In univariate analysis, bronchiectasis, lung destruction, a calcified granuloma, and cavitation were more frequently observed in multidrug-resistant tuberculosis than in drug-sensitive tuberculosis. Multivariate analysis showed that cavity formation was the only significant difference between multidrug-resistant tuberculosis and drug-sensitive tuberculosis. In patients with cavitary tuberculosis, multiple cavities (>3 cavities) were observed only in patients with multidrug-resistant tuberculosis.

CONCLUSIONS

Most patients with multidrug-resistant tuberculosis had cavity formation on CT. Although the presence of a cavity does not mean multidrug resistance, multiple cavities suggest the possibility of multidrug-resistant tuberculosis.