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Meaza A, Diriba G, Girma M, Wondimu A, Worku G, Medhin G, Ameni G, Gumi B. Molecular typing and drug sensitivity profiles of M. Tuberculosis isolated from refugees residing in Ethiopia. J Clin Tuberc Other Mycobact Dis 2023; 31:100371. [PMID: 37113677 PMCID: PMC10127110 DOI: 10.1016/j.jctube.2023.100371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Background Refugees in developing countries have poor access to Tuberculosis (TB) care and control services. The understanding of genetic diversity and drug sensitivity patterns of M. tuberculosis (MTB) is important for the TB control program. However, there is no evidence that shows the drug sensitivity profiles and genetic diversity of MTB circulating among refugees residing in Ethiopia. This study aimed to investigate the genetic diversity of MTB strains and lineages, and to identify the drug sensitivity profiles of MTB isolated from refugees residing in Ethiopia. Methods A cross-sectional study was conducted among 68 MTB positive cases isolated from presumptive TB refugees from February to August 2021. Data and samples were collected in the refugee camp clinics and both rapid TB Ag detection and region of difference (RD)-9 deletion typing were used to confirm the MTBs. Drug susceptibility test (DST) and molecular typing were done using Mycobacterium Growth Indicator Tube (MGIT) method and spoligotyping respectively. Results DST and spoligotyping results were available for all 68 isolates. The isolates were grouped into 25 spoligotype patterns, which consisted of 1-31 isolates with 36.8% strain diversity. The international shared type (SIT)25 was predominant spoligotype pattern consisting of 31 (45.6%) isolates, followed by SIT24 comprising 5 (7.4%) isolates. Further investigation showed that 64.7% (44/68) of the isolates were belonged to CAS1-Delhi family and 75% (51/68) of the isolates were belonged to lineage(L)-3. Multi-drug resistance (MDR)-TB was observed only in one isolate (1.5%) for first-line anti-TB drugs and the highest level of mono-resistance, 5.9% (4/68), was observed for PZA(Pyrazinamide). Mono-resistance was observed in 2.9 % (2/68) and while 97.0% (66/68) of the MTB positive cases were susceptible to the second-line anti-TB drugs. Conclusion The findings are useful evidence for the TB screening, treatment and control in refugee populations and surrounding communities in Ethiopia.
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Affiliation(s)
- Abyot Meaza
- Aklilu Lemma Institute of Pathobiology (ALIPB), Addis Ababa University (AAU), P.O. Box 1176, Addis Ababa, Ethiopia
- Ethiopian Public Health Institute (EPHI), PO Box 1242, Swaziland Street, Addis Ababa, Ethiopia
- Corresponding author.
| | - Getu Diriba
- Ethiopian Public Health Institute (EPHI), PO Box 1242, Swaziland Street, Addis Ababa, Ethiopia
| | - Musse Girma
- Aklilu Lemma Institute of Pathobiology (ALIPB), Addis Ababa University (AAU), P.O. Box 1176, Addis Ababa, Ethiopia
| | - Ammanuel Wondimu
- Ethiopian Public Health Institute (EPHI), PO Box 1242, Swaziland Street, Addis Ababa, Ethiopia
| | - Getnet Worku
- Aklilu Lemma Institute of Pathobiology (ALIPB), Addis Ababa University (AAU), P.O. Box 1176, Addis Ababa, Ethiopia
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Jigjiga University, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology (ALIPB), Addis Ababa University (AAU), P.O. Box 1176, Addis Ababa, Ethiopia
| | - Gobena Ameni
- Aklilu Lemma Institute of Pathobiology (ALIPB), Addis Ababa University (AAU), P.O. Box 1176, Addis Ababa, Ethiopia
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, United Arab Emirates University, PO Box 15551, Al Ain, United Arab Emirates
| | - Balako Gumi
- Aklilu Lemma Institute of Pathobiology (ALIPB), Addis Ababa University (AAU), P.O. Box 1176, Addis Ababa, Ethiopia
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Dorjee K, Topgyal S, Tsewang T, Tsundue T, Namdon T, Bonomo E, Kensler C, Lhadon D, Choetso T, Nangsel T, Dolkar T, Tsekyi T, Dorjee C, Phunkyi D, Sadutshang TD, Paster Z, Chaisson RE. Risk of developing active tuberculosis following tuberculosis screening and preventive therapy for Tibetan refugee children and adolescents in India: An impact assessment. PLoS Med 2021; 18:e1003502. [PMID: 33465063 PMCID: PMC7853467 DOI: 10.1371/journal.pmed.1003502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 02/02/2021] [Accepted: 12/29/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) rates among Tibetan refugee children and adolescents attending boarding schools in India are extremely high. We undertook a comprehensive case finding and TB preventive treatment (TPT) program in 7 schools in the Zero TB Kids project. We aimed to measure the TB infection and disease burden and investigate the risk of TB disease in children and adults who did and did not receive TPT in the schools. METHODS AND FINDINGS A mobile team annually screened children and staff for TB at the 7 boarding schools in Himachal Pradesh, India, using symptom criteria, radiography, molecular diagnostics, and tuberculin skin tests. TB infection (TBI) was treated with short-course regimens of isoniazid and rifampin or rifampin. TB disease was treated according to Tibetan and Indian guidelines. Between April 2017 and December 2019, 6,582 schoolchildren (median age 14 [IQR 11-16] years) and 807 staff (median age 40 [IQR 33-48] years) were enrolled. Fifty-one percent of the students and 58% of the staff were females. Over 13,161 person-years of follow-up in schoolchildren (median follow-up 2.3 years) and 1,800 person-years of follow-up in staff (median follow-up 2.5 years), 69 TB episodes occurred in schoolchildren and 4 TB episodes occurred in staff, yielding annual incidence rates of 524/100,000 (95% CI 414-663/100,000) person-years and 256/100,000 (95% CI 96-683/100,000) person-years, respectively. Of 1,412 schoolchildren diagnosed with TBI, 1,192 received TPT. Schoolchildren who received TPT had 79% lower risk of TB disease (adjusted hazard ratio [aHR] 0.21; 95% CI 0.07-0.69; p = 0.010) compared to non-recipients, the primary study outcome. Protection was greater in recent contacts (aHR 0.07; 95% CI 0.01-0.42; p = 0.004), the secondary study outcome. The prevalence of recent contacts was 28% (1,843/6,582). Two different TPT regimens were used (3HR and 4R), and both were apparently effective. No staff receiving TPT developed TB. Overall, between 2017 and 2019, TB disease incidence decreased by 87%, from 837/100,000 (95% CI 604-1,129/100,000) person-years to 110/100,000 (95% CI 36-255/100,000) person-years (p < 0.001), and TBI prevalence decreased by 42% from 19% (95% CI 18%-20%) to 11% (95% CI 10%-12%) (p < 0.001). A limitation of our study is that TB incidence could be influenced by secular trends during the study period. CONCLUSIONS In this study, following implementation of a school-wide TB screening and preventive treatment program, we observed a significant reduction in the burden of TB disease and TBI in children and adolescents. The benefit of TPT was particularly marked for recent TB contacts. This initiative may serve as a model for TB detection and prevention in children and adolescents in other communities affected by TB.
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Affiliation(s)
- Kunchok Dorjee
- Center for TB Research, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
| | - Sonam Topgyal
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Tenzin Tsewang
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Tenzin Tsundue
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Tenzin Namdon
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Elizabeth Bonomo
- Center for TB Research, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Caroline Kensler
- Center for TB Research, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Dekyi Lhadon
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Tsering Choetso
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Tenzin Nangsel
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Tsering Dolkar
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Thupten Tsekyi
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | | | - Dawa Phunkyi
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Tsetan D. Sadutshang
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Zorba Paster
- Department of Family Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Richard E. Chaisson
- Center for TB Research, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
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Dorjee K, Topgyal S, Dorjee C, Tsundue T, Namdol T, Tsewang T, Nangsel T, Lhadon D, Choetso T, Dawa T, Phentok T, DeLuca AN, Tsering L, Phunkyi D, Sadutshang TD, J Bonomo E, Paster Z, Chaisson RE. High Prevalence of Active and Latent Tuberculosis in Children and Adolescents in Tibetan Schools in India: The Zero TB Kids Initiative in Tibetan Refugee Children. Clin Infect Dis 2020; 69:760-768. [PMID: 30462191 PMCID: PMC6695512 DOI: 10.1093/cid/ciy987] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/16/2018] [Indexed: 01/27/2023] Open
Abstract
Background Tuberculosis (TB) prevalence is high among Tibetan refugees in India, with almost half of cases occurring in congregate facilities, including schools. A comprehensive program of TB case finding and treatment of TB infection (TBI) was undertaken in schools for Tibetan refugee children. Methods Schoolchildren and staff in Tibetan schools in Himachal Pradesh, India, were screened for TB with an algorithm using symptoms, chest radiography, molecular diagnostics, and tuberculin skin testing. Individuals with active TB were treated and those with TBI were offered isoniazid-rifampicin preventive therapy for 3 months. Results From April 2017 to March 2018, we screened 5391 schoolchildren (median age, 13 years) and 786 staff in 11 Tibetan schools. Forty-six TB cases, including 1 with multidrug resistance, were found in schoolchildren, for a prevalence of 853 per 100 000. Extensively drug-resistant TB was diagnosed in 1 staff member. The majority of cases (66%) were subclinical. TBI was detected in 930 of 5234 (18%) schoolchildren and 334 of 634 (53%) staff who completed testing. Children in boarding schools had a higher prevalence of TBI than children in day schools (915/5020 [18%] vs 15/371 [4%]; P < .01). Preventive therapy was provided to 799 of 888 (90%) schoolchildren and 101 of 332 (30%) staff with TBI; 857 (95%) people successfully completed therapy. Conclusions TB prevalence is extremely high among Tibetan schoolchildren. Effective active case finding and a high uptake and completion of preventive therapy for children were achieved. With leadership and community mobilization, TB control is implementable on a population level.
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Affiliation(s)
- Kunchok Dorjee
- Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sonam Topgyal
- Division of Tuberculosis, Tibetan Delek Hospital, Dharamsala, India
| | | | - Tenzin Tsundue
- Division of Tuberculosis, Tibetan Delek Hospital, Dharamsala, India
| | - Tenzin Namdol
- Division of Tuberculosis, Tibetan Delek Hospital, Dharamsala, India
| | - Tenzin Tsewang
- Division of Tuberculosis, Tibetan Delek Hospital, Dharamsala, India
| | - Tenzin Nangsel
- Division of Tuberculosis, Tibetan Delek Hospital, Dharamsala, India
| | - Dekyi Lhadon
- Division of Tuberculosis, Tibetan Delek Hospital, Dharamsala, India
| | - Tsering Choetso
- Division of Tuberculosis, Tibetan Delek Hospital, Dharamsala, India
| | - Tenzin Dawa
- Division of Tuberculosis, Tibetan Delek Hospital, Dharamsala, India
| | - Tenzin Phentok
- Division of Tuberculosis, Tibetan Delek Hospital, Dharamsala, India
| | - Andrea N DeLuca
- Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lobsang Tsering
- Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Dawa Phunkyi
- Division of Tuberculosis, Tibetan Delek Hospital, Dharamsala, India
| | | | - Elizabeth J Bonomo
- Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zorba Paster
- Department of Family Medicine and Community Health, University of Wisconsin-Madison
| | - Richard E Chaisson
- Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abd El Ghany M, Fouz N, Hill-Cawthorne GA. Human Movement and Transmission of Antimicrobial-Resistant Bacteria. THE HANDBOOK OF ENVIRONMENTAL CHEMISTRY 2020:311-344. [DOI: 10.1007/698_2020_560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Dobler CC, Fox GJ, Douglas P, Viney KA, Ahmad Khan F, Temesgen Z, Marais BJ. Screening for tuberculosis in migrants and visitors from high-incidence settings: present and future perspectives. Eur Respir J 2018; 52:13993003.00591-2018. [PMID: 29794133 DOI: 10.1183/13993003.00591-2018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/17/2018] [Indexed: 12/26/2022]
Abstract
In most settings with a low incidence of tuberculosis (TB), foreign-born people make up the majority of TB cases, but the distribution of the TB risk among different migrant populations is often poorly quantified. In addition, screening practices for TB disease and latent TB infection (LTBI) vary widely. Addressing the risk of TB in international migrants is an essential component of TB prevention and care efforts in low-incidence countries, and strategies to systematically screen for, diagnose, treat and prevent TB among this group contribute to national and global TB elimination goals.This review provides an overview and critical assessment of TB screening practices that are focused on migrants and visitors from high to low TB incidence countries, including pre-migration screening and post-migration follow-up of those deemed to be at an increased risk of developing TB. We focus mainly on migrants who enter the destination country via application for a long-stay visa, as well as asylum seekers and refugees, but briefly consider issues related to short-term visitors and those with long-duration multiple-entry visas. Issues related to the screening of children and screening for LTBI are also explored.
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Affiliation(s)
- Claudia C Dobler
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.,Mayo Clinic Center for Tuberculosis, Rochester, MN, USA
| | - Greg J Fox
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.,Central Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, Australia
| | - Paul Douglas
- International Organization for Migration (IOM), Geneva, Switzerland
| | - Kerri A Viney
- Dept of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Research School of Population Health, Australian National University, Canberra, Australia
| | - Faiz Ahmad Khan
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Depts of Medicine and Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | | | - Ben J Marais
- The Children's Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), University of Sydney, Sydney, Australia
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Ismail MB, Rafei R, Dabboussi F, Hamze M. Tuberculosis, war, and refugees: Spotlight on the Syrian humanitarian crisis. PLoS Pathog 2018; 14:e1007014. [PMID: 29879218 PMCID: PMC5991642 DOI: 10.1371/journal.ppat.1007014] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mohamad Bachar Ismail
- Health and Environment Microbiology Laboratory, Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Rayane Rafei
- Health and Environment Microbiology Laboratory, Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Fouad Dabboussi
- Health and Environment Microbiology Laboratory, Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Monzer Hamze
- Health and Environment Microbiology Laboratory, Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
- * E-mail:
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Prasad R, Singh A, Balasubramanian V, Gupta N. Extensively drug-resistant tuberculosis in India: Current evidence on diagnosis & management. Indian J Med Res 2018; 145:271-293. [PMID: 28749390 PMCID: PMC5555056 DOI: 10.4103/ijmr.ijmr_177_16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Emergence of extensively drug-resistant tuberculosis (XDR-TB) has significantly threatened to jeopardize global efforts to control TB, especially in HIV endemic regions. XDR-TB is mainly an iatrogenically created issue, and understanding the epidemiological and risk factors associated with it is of paramount importance in curbing this menace. Emergence of this deadly phenomenon can be prevented by prompt diagnosis and effective treatment with second-line drugs in rifampicin-resistant TB (RR-TB) as well as multidrug-resistant TB (MDR-TB) patients. Optimal treatment of RR-TB, MDR-TB and XDR-TB cases alone will not suffice to reduce the global burden. The TB control programmes need to prioritize on policies focusing on the effective as well as rational use of first-line drugs in every newly diagnosed drug susceptible TB patients so as to prevent the emergence of drug resistance.
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Affiliation(s)
- Rajendra Prasad
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Abhijeet Singh
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | | | - Nikhil Gupta
- Department of Medicine, Era's Medical College, Lucknow, India
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Parmar MM, Sachdeva KS, Dewan PK, Rade K, Nair SA, Pant R, Khaparde SD. Unacceptable treatment outcomes and associated factors among India's initial cohorts of multidrug-resistant tuberculosis (MDR-TB) patients under the revised national TB control programme (2007-2011): Evidence leading to policy enhancement. PLoS One 2018; 13:e0193903. [PMID: 29641576 PMCID: PMC5894982 DOI: 10.1371/journal.pone.0193903] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 02/21/2018] [Indexed: 11/23/2022] Open
Abstract
Background Globally, India has the world’s highest burden of multidrug-resistant tuberculosis (MDR-TB). Programmatic Management of Drug Resistant TB (PMDT) in India began in 2007 and nationwide coverage was achieved in early 2013. Poor initial microbiological outcomes under the Revised National Tuberculosis Control Programme (RNTCP) prompted detailed analysis. This is the first study on factors significantly associated with poor outcomes in MDR-TB patients treated under the RNTCP. Objective To evaluate initial sputum culture conversion, culture reversion and final treatment outcomes among MDR-TB patients registered in India from 2007 to early 2011 who were treated with a standard 24-month regimen under daily-observed treatment. Methods This is a retrospective cohort study. Clinical and microbiological data were abstracted from PMDT records. Initial sputum culture conversion, culture reversion and treatment outcomes were defined by country adaptation of the standard WHO definitions (2008). Cox proportional hazards modeling with logistic regression, multinomial logistic regression and adjusted odds ratio was used to evaluate factors associated with interim and final outcomes respectively, controlling for demographic and clinical characteristics. Results In the cohort of 3712 MDR-TB patients, 2735 (73.6%) had initial sputum culture conversion at 100 median days (IQR 92–125), of which 506 (18.5%) had culture reversion at 279 median days (IQR 202–381). Treatment outcomes were available for 2264 (60.9%) patients while 1448 (39.0%) patients were still on treatment or yet to have a definite outcome at the time of analysis. Of 2264 patients, 781 (34.5%) had treatment success, 644 (28.4%) died, 670 (29.6%) were lost to follow up, 169 (7.5%) experienced treatment failure or were changed to XDR-TB treatment. Factors significantly associated with either culture non-conversion, culture reversion and/or unfavorable treatment outcomes were baseline BMI < 18; ≥ seven missed doses in intensive phase (IP) and continuation phase (CP); cavitary disease; prior treatment episodes characterized by re-treatment regimen taken twice, longer duration and more episodes of treatment; any weight loss during treatment; males and additional resistance to first line drugs (Ethambutol, Streptomycin). In a subgroup of 104 MDR-TB patients, 62 (59.6%) had Ofloxacin resistance among whom only 25.8% had treatment success, half of the success (54.8%) seen in Ofloxacin sensitive patients. Baseline susceptibility to Ofloxacin (HR 2.04) and Kanamycin (HR 4.55) significantly doubled and quadrupled the chances for culture conversion respectively while baseline susceptibility to Ofloxacin (AOR 0.37) also significantly reduced the odds of unfavorable treatment outcomes (p value ≤0.05) in multinomial logistic regression model. Conclusion India’s initial MDR-TB patients’ cohort treated under the RNTCP experienced poor treatment outcomes. To address the factors associated with poor treatment outcomes revealed in our study, a systematic multi-pronged approach would be needed. A series of policies and interventions have been developed to address these factors to improve DR-TB treatment outcomes and are being scaled-up in India.
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Affiliation(s)
- Malik M. Parmar
- World Health Organization–Country Office for India, New Delhi, India
- * E-mail:
| | - Kuldeep Singh Sachdeva
- National AIDS Control Organization, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Puneet K. Dewan
- Bill & Melinda Gates Foundation, India Country Office, New Delhi, India
| | - Kiran Rade
- World Health Organization–Country Office for India, New Delhi, India
| | - Sreenivas A. Nair
- World Health Organization–Country Office for India, New Delhi, India
| | - Rashmi Pant
- Public Health Foundation of India, Hyderabad, India
| | - Sunil D. Khaparde
- Central TB Division, Ministry of Health and Family Welfare, Government of India, New Delhi, India
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Dierberg KL, Dorjee K, Salvo F, Cronin WA, Boddy J, Cirillo D, Sadutshang T, Chaisson RE. Improved Detection of Tuberculosis and Multidrug-Resistant Tuberculosis among Tibetan Refugees, India. Emerg Infect Dis 2016; 22:463-8. [PMID: 26889728 PMCID: PMC4766920 DOI: 10.3201/eid2203.140732] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The incidence of tuberculosis (TB) among Tibetan refugees in India is 431 cases/100,000 persons, compared with 181 cases/100,000 persons overall in India in 2010. More than half of TB cases in these refugees occur among students, monks, and nuns in congregate settings. We sought to increase TB case detection rates for this population through active case finding and rapid molecular diagnostics. We screened 27,714 persons for symptoms of TB and tested 3,830 symptomatic persons by using an algorithm incorporating chest radiography, sputum smear microscopy, culture, and a rapid diagnostic test; 96 (2.5%) cases of TB were detected (prevalence 346 cases/100,000 persons). Of these cases, 5% were multidrug-resistant TB. Use of the rapid diagnostic test and active case finding enabled rapid detection of undiagnosed TB cases in congregate living settings, which would not have otherwise been identified. The burden of TB in the Tibetan exile population in India is extremely high and requires urgent attention.
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Management and control of multidrug-resistant tuberculosis (MDR-TB): Addressing policy needs for India. J Public Health Policy 2016; 37:277-299. [PMID: 27153155 DOI: 10.1057/jphp.2016.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Multidrug-resistant tuberculosis (MDR-TB) challenges TB control efforts because of delays in diagnosis plus its long-term treatment which has toxic effects. Of TB high-incidence countries, India carries the highest burden of MDR-TB cases. We describe policy issues in India concerning MDR-TB diagnosis and management in a careful review of the literature including a systematic review of studies on the prevalence of MDR-TB. Of 995 articles published during 2001-2016 and retrieved from the PubMed, only 20 provided data on the population prevalence of MDR-TB. We further reviewed and describe diagnostic criteria and treatment algorithms in use and endorsed by the Revised National TB Control Program of India. We discuss problems encountered in treating MDR-TB patients with standardized regimens. Finally, we provide realistic suggestions for policymakers and program planners to improve the management and control of MDR-TB in India.Journal of Public Health Policy advance online publication, 6 May 2016; doi:10.1057/jphp.2016.14.
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11
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Udwadia ZF, Mullerpattan JB, Shah KD, Rodrigues CS. Possible impact of the standardized Category IV regimen on multidrug-resistant tuberculosis patients in Mumbai. Lung India 2016; 33:253-6. [PMID: 27185987 PMCID: PMC4857559 DOI: 10.4103/0970-2113.180800] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Treatment of multidrug-resistant tuberculosis (MDR-TB) in the Programmatic Management of Drug-resistant TB program involves a standard regimen with a 6-month intensive phase and an 18-month continuation phase. However, the local drug resistance patterns in high MDR regions such as Mumbai may not be adequately reflected in the design of the regimen for that particular area. SETTING The study was carried out at a private Tertiary Level Hospital in Mumbai in a mycobacteriology laboratory equipped to perform the second-line drug susceptibility testing (DST). OBJECTIVE We attempted to analyze the impact of prescribing the standardized Category IV regimen to all patients receiving a DST at our mycobacteriology laboratory. MATERIALS AND METHODS All samples confirmed to be MDR-TB and tested for the second-line drugs at Hinduja Hospital's Mycobacteriology Laboratory in the year 2012 were analyzed. RESULTS A total of 1539 samples were analyzed. Of these, 464 (30.14%) were MDR-TB, 867 (56.33%) were MDR with fluoroquinolone resistance, and 198 (12.8%) were extensively drug-resistant TB. The average number of susceptible drugs per sample was 3.07 ± 1.29 (assuming 100% cycloserine susceptibility). Taking 4 effective drugs to be the cut or an effective regimen, the number of patients receiving 4 or more effective drugs from the standardized directly observed treatment, short-course plus regimen would be 516 (33.5%) while 66.5% of cases would receive 3 or less effective drugs. CONCLUSION Our study shows that a high proportion of patients will have resistance to a number of the first- and second-line drugs. Local epidemiology must be factored in to avoid amplification of resistance.
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Affiliation(s)
- Zarir F Udwadia
- Department of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
| | - Jai Bharat Mullerpattan
- Department of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
| | - Kushal D Shah
- Department of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
| | - Camilla S Rodrigues
- Department of Microbiology, P.D. Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
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Jabeen K, Shakoor S, Hasan R. Fluoroquinolone-resistant tuberculosis: implications in settings with weak healthcare systems. Int J Infect Dis 2016; 32:118-23. [PMID: 25809767 DOI: 10.1016/j.ijid.2015.01.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/05/2015] [Accepted: 01/06/2015] [Indexed: 01/26/2023] Open
Abstract
Fluoroquinolones (FQ) play an essential role in the treatment and control of multidrug-resistant tuberculosis (MDR-TB). They are also being evaluated as part of newer regimens under development for drug-sensitive TB. As newer FQ-based regimens are explored, knowledge of FQ resistance data from high TB burden countries becomes essential. We examine available FQ resistance data from high TB burden countries and demonstrate the need for comprehensive surveys to evaluate FQ resistance in these countries. The factors driving FQ resistance in such conditions and the cost of such resistance to weak healthcare systems are discussed. The need for a comprehensive policy for addressing the issue of FQ resistance is highlighted.
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Affiliation(s)
- Kauser Jabeen
- Department of Pathology and Microbiology, Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan
| | - Sadia Shakoor
- Department of Pathology and Microbiology, Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan
| | - Rumina Hasan
- Department of Pathology and Microbiology, Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan.
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Theron G, Jenkins HE, Cobelens F, Abubakar I, Khan AJ, Cohen T, Dowdy DW. Data for action: collection and use of local data to end tuberculosis. Lancet 2015; 386:2324-33. [PMID: 26515676 PMCID: PMC4708262 DOI: 10.1016/s0140-6736(15)00321-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Accelerating progress in the fight against tuberculosis will require a drastic shift from a strategy focused on control to one focused on elimination. Successful disease elimination campaigns are characterised by locally tailored responses that are informed by appropriate data. To develop such a response to tuberculosis, we suggest a three-step process that includes improved collection and use of existing programmatic data, collection of additional data (eg, geographic information, drug resistance, and risk factors) to inform tailored responses, and targeted collection of novel data (eg, sequencing data, targeted surveys, and contact investigations) to improve understanding of tuberculosis transmission dynamics. Development of a locally targeted response for tuberculosis will require substantial investment to reconfigure existing systems, coupled with additional empirical data to evaluate the effectiveness of specific approaches. Without adoption of an elimination strategy that uses local data to target hotspots of transmission, ambitious targets to end tuberculosis will almost certainly remain unmet.
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Affiliation(s)
- Grant Theron
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, and South African Medical Research Council Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; Lung Infection and Immunity Unit, Department of Medicine, University of Cape Town, Observatory, Cape Town, South Africa
| | - Helen E Jenkins
- Department of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Frank Cobelens
- KNCV Tuberculosis Foundation, The Hague, Netherlands; Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, Netherlands
| | | | - Aamir J Khan
- Interactive Research & Development, Karachi, Pakistan
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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A review of the use of ethionamide and prothionamide in childhood tuberculosis. Tuberculosis (Edinb) 2015; 97:126-36. [PMID: 26586647 DOI: 10.1016/j.tube.2015.09.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/26/2015] [Accepted: 09/16/2015] [Indexed: 11/21/2022]
Abstract
Ethionamide (ETH) and prothionamide (PTH), both thioamides, have proven efficacy in clinical studies and form important components for multidrug-resistant tuberculosis treatment regimens and for treatment of tuberculous meningitis in adults and children. ETH and PTH are pro-drugs that, following enzymatic activation by mycobacterial EthA inhibit InhA, a target shared with isoniazid (INH), and subsequently inhibit mycolic acid synthesis of Mycobacterium tuberculosis. Co-resistance to INH and ETH is conferred by mutations in the mycobacterial inhA promoter region; mutations in the ethA gene often underlie ETH and PTH monoresistance. An oral daily dose of ETH or PTH of 15-20 mg/kg with a maximum daily dose of 1000 mg is recommended in children to achieve adult-equivalent serum concentrations shown to be efficacious in adults, although information on optimal pharmacodynamic targets is still lacking. Gastrointestinal disturbances, and hypothyroidism during long-term therapy, are frequent adverse effects observed in adults and children, but are rarely life-threatening and seldom necessitate cessation of ETH therapy. More thorough investigation of the therapeutic effects and toxicity of ETH and PTH is needed in childhood TB while child-friendly formulations are needed to appropriately dose children.
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15
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Dorjee K, Dierberg KL, Sadutshang TD, Reingold AL. First report of multi-drug resistant tuberculosis in a systemic lupus erythematosus patient. BMC Res Notes 2015; 8:337. [PMID: 26245637 PMCID: PMC4527098 DOI: 10.1186/s13104-015-1302-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment of a multi-drug resistant tuberculosis (MDR-TB) patient is clinically challenging, requiring a minimum of 18 months of therapy. Its occurrence in a systemic lupus erythromatosus (SLE) patient may complicate management of both MDR-TB and SLE. This is the first descriptive report of MDR-TB in an SLE patient. CASE PRESENTATION A 19-year old female receiving long-term prednisolone for SLE was diagnosed with MDR-TB. She was started on MDR-TB treatment regimen and prednisolone was replaced with azathioprine. After an initial response to therapy, patient experienced a flare of lupus symptoms. Imaging studies revealed avascular necrosis of right femoral head. She was then treated with intravenous methyl-prednisolone, followed by maintenance corticosteroid. Azathioprine was discontinued due to hematological toxicity and failure to control SLE. Her symptoms of lupus regressed and did not re-occur for the duration of her MDR-TB treatment. Patient was declared cured of MDR-TB after 18 months of ATT. She is currently scheduled for a total hip replacement surgery. CONCLUSIONS This case highlights the challenges of simultaneously managing MDR-TB and SLE in a patient due to their over-lapping signs and symptoms, drug-drug interactions, and the need for use of immunomodulatory agents in the absence of standard guidelines and documented previous experiences. Our experience underscores the importance of appropriate selection of treatment regimens for both MDR-TB and SLE.
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Affiliation(s)
- Kunchok Dorjee
- Division of Epidemiology, School of Public Health, University of California, Berkeley, 113 Haviland Hall #7358, Berkeley, CA, 94720-7358, USA. .,The Tibetan Delek Hospital, Dharamshala, Himachal Pradesh, India.
| | - Kerry L Dierberg
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | - Arthur L Reingold
- Division of Epidemiology, School of Public Health, University of California, Berkeley, 113 Haviland Hall #7358, Berkeley, CA, 94720-7358, USA.
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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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Cain KP, Marano N, Kamene M, Sitienei J, Mukherjee S, Galev A, Burton J, Nasibov O, Kioko J, De Cock KM. The movement of multidrug-resistant tuberculosis across borders in East Africa needs a regional and global solution. PLoS Med 2015; 12:e1001791. [PMID: 25710472 PMCID: PMC4339836 DOI: 10.1371/journal.pmed.1001791] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Kevin Cain and colleagues reflect on the cross border movement of people from Somalia with MDR-TB and the implications for MDR-TB programs in East Africa.
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Affiliation(s)
- Kevin P. Cain
- United States Centers for Disease Control and Prevention, Kisumu and Nairobi, Kenya
- * E-mail:
| | - Nina Marano
- United States Centers for Disease Control and Prevention, Kisumu and Nairobi, Kenya
| | | | | | - Subroto Mukherjee
- United States Agency for International Development, East Africa Regional Office, Nairobi, Kenya
| | - Aleksandar Galev
- International Organization for Migration, Dadaab and Nairobi, Kenya
| | - John Burton
- United Nations High Commissioner for Refugees, Nairobi, Kenya
| | - Orkhan Nasibov
- United Nations High Commissioner for Refugees, Nairobi, Kenya
| | | | - Kevin M. De Cock
- United States Centers for Disease Control and Prevention, Kisumu and Nairobi, Kenya
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