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Salari N, Kanjoori AH, Hosseinian-Far A, Hasheminezhad R, Mansouri K, Mohammadi M. Global prevalence of drug-resistant tuberculosis: a systematic review and meta-analysis. Infect Dis Poverty 2023; 12:57. [PMID: 37231463 DOI: 10.1186/s40249-023-01107-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Tuberculosis is a bacterial infectious disease, which affects different parts of a human body, mainly lungs and can lead to the patient's death. The aim of this study is to investigate the global prevalence of drug-resistant tuberculosis using a systematic review and meta-analysis. METHODS In this study, the PubMed, Scopus, Web of Science, Embase, ScienceDirect and Google Scholar repositories were systematically searched to find studies reporting the global prevalence of drug-resistant tuberculosis. The search did not entail a lower time limit, and articles published up until August 2022 were considered. Random effects model was used to perform the analysis. The heterogeneity of the studies was examined with the I2 test. Data analysis was conducted within the Comprehensive Meta-Analysis software. RESULTS In the review of 148 studies with a sample size of 318,430 people, the I2 index showed high heterogeneity (I2 = 99.6), and accordingly random effects method was used to analyze the results. Publication bias was also examined using the Begg and Mazumdar correlation test which indicated the existence of publication bias in the studies (P = 0.008). According to our meta-analysis, the global pooled prevalence of multi-drug resistant TB is 11.6% (95% CI: 9.1-14.5%). CONCLUSIONS The global prevalence of drug-resistant tuberculosis was found to be very high, thus health authorities should consider ways to control and manage the disease to prevent a wider spread of tuberculosis and potentially subsequent deaths.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Hossein Kanjoori
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amin Hosseinian-Far
- Department of Business Systems & Operations, University of Northampton, Northampton, UK
| | - Razie Hasheminezhad
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kamran Mansouri
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
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Desikan P, Panwalkar N, Punde RP, Khan Z, Pauranik A, Mirza SB, Chourey M, Anand S, Sachdeva K. Heteroresistance to rifampicin & isoniazid in clinical samples of patients with presumptive drug-resistant tuberculosis in Central India. Indian J Med Res 2023; 157:174-182. [PMID: 37202936 PMCID: PMC10319389 DOI: 10.4103/ijmr.ijmr_607_22] [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: 03/09/2022] [Indexed: 04/28/2023] Open
Abstract
Background & objectives A combination of resistant and susceptible Mycobacterium tuberculosis (MTB) isolated from clinical specimens is referred to as heteroresistance. Heteroresistance leads to difficulties in drug resistance testing and may adversely affect treatment outcomes. The present study estimated the proportion of heteroresistance among MTB in clinical samples of presumptive drug-resistant tuberculosis (TB) patients in Central India. Methods A retrospective analysis of data generated from line probe assay (LPA) at a tertiary care hospital in Central India between January 2013 and December 2018 was carried out. A heteroresistant MTB in a sample was indicated by the presence of both wild-type and mutant-type patterns on an LPA strip. Results Data analysis was carried out on interpretable 11,788 LPA results. Heteroresistance in MTB was detected in 637 (5.4%) samples. Of these, heteroresistance in MTB was detected in 413 (64.8%), 163 (25.5%) and 61 (9.5%) samples with respect to rpoB, katG and inhA genes, respectively. Interpretation & conclusions Heteroresistance is considered a preliminary step in the development of drug resistance. Delayed or suboptimal anti-tubercular therapy in patients with heteroresistance of MTB may elicit full clinical resistance and negatively impact the National TB Elimination Programme. Further studies are, however, needed to determine the impact of heteroresistance on treatment outcomes in individual patients.
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Affiliation(s)
- Prabha Desikan
- ICMR-Bhopal Memorial Hospital & Research Centre, Bhopal, Madhya Pradesh, India
| | | | | | - Zeba Khan
- Department of Microbiology, Bhopal, Madhya Pradesh, India
| | - Ankur Pauranik
- Department of Microbiology, Bhopal, Madhya Pradesh, India
| | | | - Manju Chourey
- Department of Microbiology, Bhopal, Madhya Pradesh, India
| | - Sridhar Anand
- World Health Organization, Ministry of Health & Family Welfare, New Delhi, India
| | - K.S. Sachdeva
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, India
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Mishra P, Sharma RK, Yadav R, Rao VG, Nigam S, Lingala MA, Bhat J. Reasons for loss to follow-up (LTFU) of pulmonary TB (PTB) patients: A qualitative study among Saharia, a particularly vulnerable tribal group of Madhya Pradesh, India. PLoS One 2021; 16:e0261152. [PMID: 34941885 PMCID: PMC8699669 DOI: 10.1371/journal.pone.0261152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/27/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Loss to follow-up (LTFU) among pulmonary tuberculosis (PTB) patients is a significant challenge for TB control. However, there is a dearth of information about the factors leading to LTFU among marginalized communities. This study highlights the factors associated with LTFU in Saharia, a tribe of Madhya Pradesh having high tuberculosis (TB) prevalence. METHODS A qualitative study was carried out during January-April 2020 among twenty-two pulmonary TB patients, recorded as LTFU in NIKSHAY, with ten treatment supporters and ten patient's family members. Semi-structured personal interview tools were used to collect the information on the history of anti-tuberculosis treatment, adverse drug events (ADE), social cognitive, behaviors, myths, and misbeliefs. The interviews were transcribed and thematically analysed to examine underlying themes. RESULTS The study explored various social, behavioral factors leading to loss to follow-up among PTB patients. Drug side effects, alcoholism, social stigma, lack of awareness of the seriousness of the diseases and poor counseling are the main barriers to treatment adherence in this community. CONCLUSIONS The study highlights the need to address the issues related to LTFU during TB treatment. The enhanced efforts of treatment supporters, health staff, and family & community persons must motivate and support the patients.
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Affiliation(s)
- Prashant Mishra
- ICMR-National Institute of Research in Tribal Health (NIRTH), Jabalpur, India
| | | | - Rajiv Yadav
- ICMR-National Institute of Research in Tribal Health (NIRTH), Jabalpur, India
| | - V. G. Rao
- ICMR-National Institute of Research in Tribal Health (NIRTH), Jabalpur, India
| | - Samridhi Nigam
- ICMR-National Institute of Research in Tribal Health (NIRTH), Jabalpur, India
| | | | - Jyothi Bhat
- ICMR-National Institute of Research in Tribal Health (NIRTH), Jabalpur, India
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Thomas BE, Thiruvengadam K, Vedhachalam C, A S, Rao VG, Vijayachari P, Rajiv Y, V R, Bansal AK, Indira Krishna AK, Joseph A, J AP, Hussain T, Anand P, Das P, John KR, Devi K. R, P S, S A, Dusthakeer A, J B, K. Chadha V, G. S. T, Raghunath D, Das M, Khan AM, Kaur H. Prevalence of pulmonary tuberculosis among the tribal populations in India. PLoS One 2021; 16:e0251519. [PMID: 34086684 PMCID: PMC8177518 DOI: 10.1371/journal.pone.0251519] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/27/2021] [Indexed: 01/10/2023] Open
Abstract
Importance There is no concrete evidence on the burden of TB among the tribal populations across India except for few studies mainly conducted in Central India with a pooled estimation of 703/100,000 with a high degree of heterogeneity. Objective To estimate the prevalence of TB among the tribal populations in India. Design, participants, setting A survey using a multistage cluster sampling design was conducted between April 2015 and March 2020 covering 88 villages (clusters) from districts with over 70% tribal majority populations in 17 States across 6 zones of India. The sample populations included individuals ≥15 years old. Main outcome and measures Eligible participants who were screened through an interview for symptoms suggestive of pulmonary TB (PTB); Two sputum specimens were examined by smear and culture. Prevalence was estimated after multiple imputations for non-coverage and a correction factor of 1.31 was then applied to account for non-inclusion of X-ray screening. Results A total of 74532 (81.0%) of the 92038 eligible individuals were screened; 2675 (3.6%) were found to have TB symptoms or h/o ATT. The overall prevalence of PTB was 432 per 100,000 populations. The PTB prevalence per 100,000 populations was highest 625 [95% CI: 496–754] in the central zone and least 153 [95% CI: 24–281] in the west zone. Among the 17 states that were covered in this study, Odisha recorded the highest prevalence of 803 [95% CI: 504–1101] and Jammu and Kashmir the lowest 127 [95% CI: 0–310] per 100,000 populations. Findings from multiple logistic regression analysis reflected that those aged 35 years and above, with BMI <18.5 Kgs /m2, h/o ATT, smoking, and/or consuming alcohol had a higher risk of bacteriologically positive PTB. Weight loss was relatively more important symptom associated with tuberculosis among this tribal populations followed by night sweats, blood in sputum, and fever. Conclusion and relevance The overall prevalence of PTB among tribal groups is higher than the general populations with a wide variation of prevalence of PTB among the tribal groups at zone and state levels. These findings call for strengthening of the TB control efforts in tribal areas to reduce TB prevalence through tribal community/site-specific intervention programs.
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Affiliation(s)
- Beena E. Thomas
- Department of Social and Behavioral Research, ICMR – National Institute for Research in Tuberculosis, Chennai, India
- * E-mail:
| | - Kannan Thiruvengadam
- Department of Statistics, Epidemiology Unit, ICMR – National Institute for Research in Tuberculosis, Chennai, India
| | - Chandrasekaran Vedhachalam
- Department of Statistics, Epidemiology Unit, ICMR – National Institute for Research in Tuberculosis, Chennai, India
| | - Srividya A
- Department of Biostatistics, ICMR – Vector Control Research Centre, Pondicherry, India
| | - V. G. Rao
- Division of Communicable Diseases, ICMR – National Institute for Research in Tribal Health, Jabalpur, India
| | - Paluru Vijayachari
- ICMR – Regional Medical Research Centre, Port Blair, Andaman and Nicobar Islands
| | - Yadav Rajiv
- Division of Communicable Diseases, ICMR – National Institute for Research in Tribal Health, Jabalpur, India
| | - Raghavi V
- Department of Social and Behavioral Research, ICMR – National Institute for Research in Tuberculosis, Chennai, India
| | - Avi Kumar Bansal
- Department of Epidemiology, ICMR – National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
| | | | - Alex Joseph
- School of Public Health, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Anil Purty J
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Tahziba Hussain
- ICMR – Regional Medical Research Centre, Bhuvaneshwar, India
| | - Praveen Anand
- Department of Epidemiology, ICMR – Desert Medicine Research Centre, Jodhpur, India
| | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - K. R. John
- Department of Community Medicine, Apollo Institute of Medical Sciences & Research, Chittoor, India
| | - Rekha Devi K.
- ICMR – Regional Medical Research Centre, Dibrugarh, India
| | - Sunish P
- ICMR – Regional Medical Research Centre, Port Blair, Andaman and Nicobar Islands
| | - Azhagendran S
- Department of Social and Behavioral Research, ICMR – National Institute for Research in Tuberculosis, Chennai, India
| | - Azger Dusthakeer
- Department of Bacteriology, ICMR – National Institute for Research in Tuberculosis, Chennai, India
| | - Bhat J
- Division of Communicable Diseases, ICMR – National Institute for Research in Tribal Health, Jabalpur, India
| | - Vineet K. Chadha
- Central Leprosy Teaching and Training Institute, Chengalpet, India
| | - Toteja G. S.
- Department of Epidemiology, ICMR – Desert Medicine Research Centre, Jodhpur, India
| | - Dasarathy Raghunath
- Tribal Task Force, ICMR – Former Dean, Armed Forces Medical College, Pune, India
| | - Madhuchhanda Das
- Division of Communicable Diseases (ECD), Indian Council of Medical Research, New Delhi, India
| | - A. M. Khan
- Division of Communicable Diseases (ECD), Indian Council of Medical Research, New Delhi, India
| | - Hapreet Kaur
- Division of Communicable Diseases (ECD), Indian Council of Medical Research, New Delhi, India
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Sharma M, Roy N, Banerjee R, Kishore J, Jakhar A. Determinants of Drug Resistance in Previously-Treated Pulmonary Tuberculosis Patients Registered at a Chest Clinic in South Delhi, India. Cureus 2019; 11:e5541. [PMID: 31523588 PMCID: PMC6721924 DOI: 10.7759/cureus.5541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction Drug-resistant tuberculosis (DR-TB) is a major concern to effective control of tuberculosis (TB) in India and the likelihood of drug resistance increases with repeated exposure to anti-TB drugs. India has emerged as one of the leading contributors of DR-TB in the world posing a major threat to TB control. In the current study, we aim to find the burden and factors associated with drug resistance in previously treated pulmonary TB patients. Methods A cross-sectional study was conducted among 230 previously treated pulmonary TB patients registered with Directly Observed Treatment, Short-course (DOTS) centers under Nehru Nagar Chest clinic in Delhi, India. The participants were selected consecutively as they registered with the chest clinic. A predesigned, pretested, semi-structured questionnaire in the Hindi language used to collect socio-demographic data and factors associated with the development of drug resistance. Physical examination of all the participants was done (height, weight, pallor). Data were analyzed using SPSS version 21. Binary logistic regression analysis was used to identify independent risk factors of drug resistance. Results Of 230 previously treated pulmonary TB patients, 80 (34.8% (95% CI:28.7-40.9%)) were drug-resistant. Age (p=0.021), ever consumption of alcohol (p= 0.001), pallor (p=0.06), BMI (p=0.028), fasting blood sugar (p=0.001), treatment failure (p=0.005) and the number of prior courses of anti-tuberculosis treatment (ATT) taken (p=0.004) were significantly associated with drug resistance. On applying binary logistic regression analysis, independently associated factors with drug resistance were ever consumption of alcohol, pallor, high fasting blood sugar level, previous treatment failure patients and the number of prior courses of ATT (p<0.05). Conclusion The findings of this study revealed that patients who had pallor, high fasting blood sugar, treatment failure and who had two or more prior courses of ATT were more likely to have DR-TB. Identifying the risk factors for drug-resistant TB is essential in facilitating the government to draw public health interventions. Further research is warranted to explore the causal associations.
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Affiliation(s)
- Manila Sharma
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Neelam Roy
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Rupsa Banerjee
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Jugal Kishore
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Ashok Jakhar
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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Prakash R, Gupta R, Sharma P, Jain S, Chauhan DS, Katoch VM, Tiwari PK. Genotypic diversity of Mycobacterium tuberculosis isolates from North-Central Indian population. Pathog Glob Health 2019; 113:39-48. [PMID: 30821646 DOI: 10.1080/20477724.2019.1583881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Different strains of Mycobacterium tuberculosis (MTB) are known to have different epidemiological and clinical characteristics. Some of them are widely distributed and associated with drug resistance, whereas others are locally predominated. Molecular epidemiological investigations have always been beneficial in identifying new strains and studying their transmission dynamics. Sahariya a primitive tribe of North Madhya Pradesh, India, has already been reported to have high prevalence of tuberculosis (TB) than their non-tribal neighbours. However, the information about MTB genotypes prevalent in Sahariya tribe and their non-tribal neighbours is not available. METHODS A total of 214 clinical isolates representing Sahariya tribe and non-tribes were analyzed by spoligotyping and MIRU-VNTR typing. RESULTS The EAI3_IND/SIT11 genotype was observed as major genotype in Sahariya tribe followed by CAS1_Delhi/SIT26 genotype. A 3.04 fold higher risk of getting TB with EAI3_IND/SIT11 genotype was observed in Sahariya as compared to the non-tribal population. The EAI_IND/SIT11 genotype also found to have more number of MDR-TB cases in Sahariya as well as true and possible transmission links. In Sahariya tribe, 3 clusters (6 isolates) reflected true transmission links, whereas 8 clusters consisted of 26 isolates revealed possible transmission links within the same geographical location or nearby houses. CONCLUSION The present study highlighted the predominance of EAI3_IND/SIT11 genotype in Sahariya tribe followed by CAS1_Delhi/SIT26 genotype. Combined approach of MIRU-VNTR typing and spoligotyping was observed more favourable in discrimination of MTB genotypes. Further, longitudinal studies using whole genome sequencing can provide more insights into genetic diversity, drug resistance and transmission dynamics of these prevalent genotypes.
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Affiliation(s)
- Ravi Prakash
- a Centre for Genomics, Molecular and Human Genetics , Jiwaji University , Gwalior , India.,b Department of Microbiology and Molecular Biology , National JALMA Institute for Leprosy and other Mycobacterial Diseases , Agra , India.,c Key Laboratory of Medical Molecular Virology , Fudan University , Shanghai , China
| | - Rahul Gupta
- a Centre for Genomics, Molecular and Human Genetics , Jiwaji University , Gwalior , India
| | - Pragya Sharma
- b Department of Microbiology and Molecular Biology , National JALMA Institute for Leprosy and other Mycobacterial Diseases , Agra , India
| | - Sanjay Jain
- d Revised National Tuberculosis Control Programme , District Hospital , Sheopur , India
| | - Devendra Singh Chauhan
- b Department of Microbiology and Molecular Biology , National JALMA Institute for Leprosy and other Mycobacterial Diseases , Agra , India
| | - Vishwa Mohan Katoch
- e Former Secretary, Department of Health Research, Govt. of India and Former Director General , Indian Council of Medical Research , Ansari Nagar , New Delhi , India.,f Rajasthan University of Health Sciences , Jaipur , India
| | - Pramod Kumar Tiwari
- a Centre for Genomics, Molecular and Human Genetics , Jiwaji University , Gwalior , India
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Rao VG, Bhat J, Yadav R, Sharma RK, Muniyandi M. Declining tuberculosis prevalence in Saharia, a particularly vulnerable tribal community in Central India: evidences for action. BMC Infect Dis 2019; 19:180. [PMID: 30786860 PMCID: PMC6383441 DOI: 10.1186/s12879-019-3815-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 02/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background In spite of an alarmingly high tuberculosis (TB) burden amongst the Saharia tribe of central India, there is hardly any study to investigate the impact of DOTS implementation on the magnitude of tuberculosis disease and the changes over time. This article present the findings of TB prevalence surveys conducted amongst this indigenous population in two different time periods to know the change in the prevalence of TB. Methods A cross sectional survey was conducted among Saharia population in Shivpuri district, Madhya Pradesh during February 2013 to May 2013 and resurvey during March 2015 to July 2015. All individuals (≥15 years) were examined for chest symptoms suggestive of TB. Sputum samples were collected from all presumptive TB cases and were confirmed by laboratory examination by Ziehl-Neelsen smear microscopy and solid media culture methods. All detected cases were referred to health facility for anti-tuberculosis treatment as per RNTCP guidelines. Results There was significant reduction (trend Chi square 19.97; OR = 1.521; p = 0.000) in the prevalence of TB at the endline (1995 per 100,000) as compared to baseline (3003 per 100,000). The reduction was significant among males as compared to females (OR 1.55; p = 0.000) and in the age group of 25–34 years (OR 2.0; p = 0.007) and 45–54 years (OR 4.39; p = 0.003). There was significant reduction in the prevalence in both smear (OR 1.29; p = 0.02) and culture positive (OR 1.57; p = 0.000) TB at the endline survey. Conclusion The study findings highlight a reduction in the prevalence of TB among Saharia tribal population. Further studies are needed to identify the factors associated with reduction in prevalence among this population and also further surveys to monitor the prevalence trend over a period.
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Affiliation(s)
- V G Rao
- ICMR -National Institute of Research in Tribal Health, (Indian Council of Medical Research), Nagpur Road, P.O. Garha, Jabalpur, 482 003, India.
| | - J Bhat
- ICMR -National Institute of Research in Tribal Health, (Indian Council of Medical Research), Nagpur Road, P.O. Garha, Jabalpur, 482 003, India
| | - R Yadav
- ICMR -National Institute of Research in Tribal Health, (Indian Council of Medical Research), Nagpur Road, P.O. Garha, Jabalpur, 482 003, India
| | - R K Sharma
- ICMR -National Institute of Research in Tribal Health, (Indian Council of Medical Research), Nagpur Road, P.O. Garha, Jabalpur, 482 003, India
| | - M Muniyandi
- ICMR -National Institute for Research in Tuberculosis, (Indian Council of Medical Research), No. 1, Mayor Sathiyamoorthy Road, Chetpet, Chennai, 600031, India
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Singhi L, Sagili KD, Sharath BN, Bhandari K, Dadul PK, Gautam M, Ravichandra C, Chadha S, Satyanarayana S. Non-response to first-line anti-tuberculosis treatment in Sikkim, India: a risk-factor analysis study. Public Health Action 2018; 8:162-168. [PMID: 30775275 DOI: 10.5588/pha.18.0026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/06/2018] [Indexed: 02/06/2023] Open
Abstract
Setting: Sikkim, India, has the highest proportion of tuberculosis (TB) patients on first-line anti-tuberculosis regimens with the outcome 'failure' or 'shifted to regimen for multidrug-resistant TB (MDR-TB)'. Objective: To assess the factors associated with non-response to treatment, i.e., 'failure' or 'shifted to MDR-TB regimen'. Methods: We conducted a retrospective cohort study using Revised National Tuberculosis Control Programme data of all TB patients registered in 2015 for first-line TB treatment. In addition, we interviewed 42 patients who had not responded to treatment to ascertain their current status. Results: Of 1508 patients enrolled for treatment, about 9% were classified as non-response to treatment. Patient factors associated with non-response were urban setting (adjusted odds ratio [aOR] 2.39, 95%CI 1.22-4.67), ethnicity (being an Indian tribal, aOR 1.73, 95%CI 1.17-2.57, Indian [other] aOR 1.83, 95%CI 1.29-2.60 compared to patients of Nepali origin) and those on retreatment (aOR 2.40, 95%CI 1.99-2.91). Of the patients interviewed, 28 (67%) had received treatment for drug-resistant TB. Conclusion: In Sikkim, one in 11 patients had not responded to first-line anti-tuberculosis treatment. Host-pathogen genetics and socio-behavioural studies may be required to understand the reasons for the differences in non-response, particularly among ethnic groups.
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Affiliation(s)
| | - K D Sagili
- International Union Against Tuberculosis and Lung Disease South-East Asia Office, New Delhi, India
| | - B N Sharath
- ESIC (Employees' State Insurance Act) Medical College and Post Graduate Institute of Medical Science and Research, Bangalore, India
| | | | | | | | | | - S Chadha
- International Union Against Tuberculosis and Lung Disease South-East Asia Office, New Delhi, India
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease South-East Asia Office, New Delhi, India
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Goyal V, Kadam V, Narang P, Singh V. Prevalence of drug-resistant pulmonary tuberculosis in India: systematic review and meta-analysis. BMC Public Health 2017; 17:817. [PMID: 29041901 PMCID: PMC5645895 DOI: 10.1186/s12889-017-4779-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/20/2017] [Indexed: 11/20/2022] Open
Abstract
Background Drug-resistant pulmonary tuberculosis (DR-TB) is a significant public health issue that considerably deters the ongoing TB control efforts in India. The purpose of this review was to investigate the prevalence of DR-TB and understand the regional variation in resistance pattern across India from 1995 to 2015, based on a large body of published epidemiological studies. Methods A systematic review of published studies reporting prevalence of DR-TB from biomedical databases (PubMed and IndMed) was conducted. Meta-analysis was performed using random effects model and the pooled prevalence estimate (95% confidence interval [CI]) of DR-TB, multidrug resistant (MDR-) TB, pre-extensively drug-resistant (pre-XDR) TB and XDR-TB were calculated across two study periods (decade 1: 1995 to 2005; decade 2: 2006 to 2015), countrywide and in different regions. Heterogeneity in this meta-analysis was assessed using I2 statistic. Results A total of 75 of 635 screened studies that fulfilled the inclusion criteria were selected. Over 40% of 45,076 isolates suspected for resistance to any first-line anti-TB drugs tested positive. Comparative analysis revealed a worsening trend in DR-TB between the two study decades (decade 1: 37.7% [95% CI = 29.0; 46.4], n = 25 vs decade 2: 46.1% [95% CI = 39.0; 53.2], n = 36). The pooled estimate of MDR-TB resistance was higher in previously treated patients (decade 1: 29.8% [95% CI = 20.7; 39.0], n = 13; decade 2: 35.8% [95% CI = 29.2; 42.4], n = 24) as compared with the newly diagnosed cases (decade 1: 4.1% [95% CI = 2.7; 5.6], n = 13; decade 2: 5.6% [95% CI = 3.8; 7.4], n = 17). Overall, studies from Western states of India reported highest prevalence of DR-TB (57.8% [95% CI = 37.4; 78.2], n = 6) and MDR-TB (39.9% [95% CI = 21.7; 58.0], n = 6) during decade 2. Prevalence of pre-XDR TB was 7.9% (95% CI = 4.4; 11.4, n = 5) with resistance to fluoroquinolone (66.3% [95% CI = 58.2; 74.4], n = 5) being the highest. The prevalence of XDR-TB was 1.9% (95% CI = 1.2; 2.6, n = 14) over the 20-year period. Conclusion The alarming increase in the trend of anti-TB drug resistance in India warrants the need for a structured nationwide surveillance to assist the National TB Control Program in strengthening treatment strategies for improved outcomes.
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Affiliation(s)
- Vishal Goyal
- Medical Affairs, Janssen India, Johnson & Johnson Pvt Ltd., Arena Space, 8th floor, Off JVLR, Jogeshwari (E), Mumbai, 400060, India
| | - Vijay Kadam
- Medical Affairs, Janssen India, Johnson & Johnson Pvt Ltd., Arena Space, 8th floor, Off JVLR, Jogeshwari (E), Mumbai, 400060, India.
| | - Prashant Narang
- Medical Affairs, Janssen India, Johnson & Johnson Pvt Ltd., Arena Space, 8th floor, Off JVLR, Jogeshwari (E), Mumbai, 400060, India
| | - Vikram Singh
- Medical Affairs, Janssen India, Johnson & Johnson Pvt Ltd., Arena Space, 8th floor, Off JVLR, Jogeshwari (E), Mumbai, 400060, India
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Das D, Satapathy P, Murmu B. First Line Anti-TB Drug Resistance in an Urban Area of Odisha, India. J Clin Diagn Res 2016; 10:DC04-DC06. [PMID: 28050363 DOI: 10.7860/jcdr/2016/20289.8846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/24/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Drug resistance is a major cause for increasing the global burden of Tuberculosis (TB). However in countries with larger geographical areas and different climatic conditions like India the prevalence of drug resistance varies from place to place. Information on anti-TB drug resistance patterns particularly among newly diagnosed cases is crucial for planning an effective TB control program. AIM To determine the prevalence of resistance against first line anti-TB drugs and Multi Drug Resistance (MDR) in Mycobacterium tuberculosis isolates. MATERIALS AND METHODS The prospective study was carried out in National Reference Laboratory (NRL) of Regional Medical Research Centre (RMRC), Bhubaneswar. During this period from January to September 2014, sputum specimens were collected from 850 suspected pulmonary TB patients attending Designated Microscopy Center (DMC) of Capital Hospital, Bhubaneswar, Odisha. Sputum specimens were subjected to Acid Fast Bacilli (AFB) smear microscopy and further processed for isolation on solid Lowenstein Jensen (LJ) medium. Drug Susceptibility Testing (DST) on isolates with first line anti-TB drugs was performed as per Revised National Tuberculosis Control Programe (RNTCP) guidelines. RESULTS Out of all the 850 suspected pulmonary TB patients subjected to AFB microscopy and solid LJ culture, isolation of Mycobacterium tuberculosis was successful only in 161 (117 new and 44 previously treated) pulmonary TB patients. On DST by the RNTCP approved proportion method, prevalence of MDR- TB among 0.85% new and 4.54% previously treated cases was observed. Prevalence of mono resistance to streptomycin, isoniazid, rifampicin and ethambutol observed among new and previously treated cases were 3.41%, 2.56%, 0, 0.85% and 2.27%, 13.6%, 2.27%, 0 respectively. Only one patient from each category showed resistance to both streptomycin and isoniazid in previously treated as well as in new case. CONCLUSION The study reports an unchanged low level of MDR-TB prevalence among new cases in an urban area of Odisha over a decade. This could be due to the success of Directly Observed Treatment Short-course (DOTS) in effective treatment of drug-susceptible TB in the state and non-transmission from primary Drug Resistance (DR) TB cases.
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Affiliation(s)
- Dasarathi Das
- Scientist-E, Regional Medical Research Centre , Bhubaneswar, Odisha, India
| | - Prakasini Satapathy
- Senior Research Fellow, ICMR, Regional Medical Research Centre , Bhubaneswar, Odisha, India
| | - Biswanath Murmu
- Technical Assistant (Research), Regional Medical Research Centre , Bhubaneswar, Odisha, India
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Krishna P, Jain A, Bisen PS. Microbiome diversity in the sputum of patients with pulmonary tuberculosis. Eur J Clin Microbiol Infect Dis 2016; 35:1205-10. [PMID: 27142586 DOI: 10.1007/s10096-016-2654-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
TB is a worldwide pandemic. India has the highest burden of TB, with WHO statistics for 2013 giving an estimated incidence figure of 2.1 million cases for India out of a global incidence of 9 million. Microbiota have been shown to be associated with many disease conditions; however, only few studies have been reported for microbiota associated with TB infection. For the first time, we characterized the composition of microbiota of TB patients of India, using high-throughput 16S rRNA gene sequencing and compared it with healthy controls. Phylum-level analysis showed that the relative abundance of Firmicutes and Actinobacteria was significantly higher in TB samples and Neisseria and Veillonella were two dominant genera after Streptococcus. In our study, significantly different core genera in TB and normal population were found as compared with the reported studies. Also, the presence of diverse opportunistic pathogenic microbiota in TB patients increases the complexity and diversity of sputum microbiota. Characterization of the sputum microbiome is likely to provide important pathogenic insights into pulmonary tuberculosis.
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Affiliation(s)
- P Krishna
- Diagnostics R&D, Avantor Performance Materials India Limited (formerly RFCL Limited), New Delhi, 110020, India
| | - A Jain
- Diagnostics R&D, Avantor Performance Materials India Limited (formerly RFCL Limited), New Delhi, 110020, India
| | - P S Bisen
- School of Studies in Biotechnology, Jiwaji University, Gwalior, 474011 M.P., India.
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Singh N. Understanding poor man's diseases in contemporary perspective. Indian J Med Res 2015; 141:501-4. [PMID: 26139764 PMCID: PMC4510745 DOI: 10.4103/0971-5916.159487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Neeru Singh
- National Institute for Research in Tribal Health (ICMR), Jabalpur 482 003, Madhya Pradesh, India & Coordinator, ICMR THRF, India
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