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Mansoori N, Pahlavanzadeh B, Atarjalali M. Risk factors associated with multidrug-resistant tuberculosis in areas with a moderate tuberculosis burden. Int Health 2024:ihae039. [PMID: 38873833 DOI: 10.1093/inthealth/ihae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/09/2024] [Accepted: 06/11/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND The emergence of multidrug-resistant tuberculosis (MDR-TB) or rifampicin-resistant (RR) TB poses a significant challenge for TB control initiatives on a global scale. This study's aim was to estimate the incidence of MDR-/RR-TB and identify the risk factors associated with their incidence in four provinces in northern Iran. METHODS Drug susceptibility testing was conducted using the proportion method on Lowenstein-Jensen media. The demographic and clinical data were collected from the Iranian TB registry. RESULTS Among 1083 individuals diagnosed with TB, 27 (2.5%) were identified as having MDR-/RR-TB, while 73 cases (6.7%) were any drug resistant (ADR). The statistical analysis revealed a significant association between marital status and MDR-/RR-TB (p=0.003). In addition, significant associations were observed between ADR-TB and gender (p=0.035) and previous treatment for TB (p=0.02). CONCLUSIONS Our findings provide important information on the drug resistance pattern of Mycobacterium tuberculosis strains, as well as risk factors in northern Iran. Given the identified risk factors, creative approaches to promote treatment adherence in TB patients, particularly divorced/widowed women and individuals with a previous history of TB treatment, are required.
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Affiliation(s)
- Noormohamad Mansoori
- Infectious Diseases Research Centre, Golestan University of Medical Sciences, Gorgan, Iran
| | - Bagher Pahlavanzadeh
- Research Center for Environmental Contaminants, Abadan University of Medical Sciences, Abadan, Iran
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Alzarea AI, Saifullah A, Khan YH, Alanazi AS, Alatawi AD, Algarni MA, Almalki ZS, Alahmari AK, Alhassan HH, Mallhi TH. Evaluation of time to sputum smear conversion and its association with treatment outcomes among drug-resistant tuberculosis patients: a retrospective record-reviewing study. Front Pharmacol 2024; 15:1370344. [PMID: 38898922 PMCID: PMC11186297 DOI: 10.3389/fphar.2024.1370344] [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] [Received: 01/17/2024] [Accepted: 04/15/2024] [Indexed: 06/21/2024] Open
Abstract
Background: This study examined the time to sputum smear and culture conversion and determinants of conversion, as well as variables associated with treatment outcomes among drug-resistant pulmonary tuberculosis (DR-PTB) cases. Methods: The electronic database and written medical records of patients were utilized to assess the sociodemographic, clinical, microbiological, and treatment characteristics and outcomes of study participants. Results: Among 736 patients with pulmonary tuberculosis (PTB), the mean age was 36.5 ± 16.5 years, with males comprising 53.4% and a mean weight of 47.76 ± 11.97 kg. The median time period for sputum smear conversion and sputum culture conversion was a month. The first-month culture conversion (p < 0.001, aOR = 5.817, and 95% CI = 3.703-9.138) was the determinant of sputum smear conversion and receiver operating curve analysis with AUC = 0.881, 95% CI = 0.855-0.907, and p < 0.001, which showed a high level of predictive ability for the regression model for the initial sputum smear conversion. However, the first-month sputum conversion (p < 0.001, aOR = 7.446, and 95% CI = 4.869-11.388) was attributed to sputum culture conversion, and the model has shown excellent predictive ability for regression with ROC curve analysis demonstrating AUC = 0.862, 95% CI = 0.835-0.889, and p < 0.001. A total of 63.2% of patients showed favorable treatment outcomes, with 63.1% of cases achieving treatment-cured status. The previous use of SLD, history of smoking, duration of illness ≤ 1 year, extensively drug-resistant tuberculosis, and first-month sputum conversion were the variables attributed to favorable treatment outcomes observed in drug-resistant pulmonary tuberculosis cases. ROC curve analysis with AUC = 0.902, 95% CI = 0.877-0.927, and p < 0.001) has shown outstanding ability for regression model prediction for the variables influencing treatment outcomes. Conclusions: Within 2 months of treatment, most patients had converted their sputum cultures and sputum smears. The determinants of early sputum smear and sputum culture conversion, as well as favorable treatment outcomes, were identified. These factors should be considered during the design and implementation of effective strategies for drug-resistant tuberculosis control programs.
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Affiliation(s)
| | - Amna Saifullah
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Adullah Salah Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Ahmed D. Alatawi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Majed Ahmed Algarni
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Ziyad Saeed Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Abdullah K. Alahmari
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Hassan H. Alhassan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
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Putra ON, Purnamasari T. Treatment Outcomes of Fluoroquinolone-Resistant Multidrug-Resistant Tuberculosis: An Implication for Delamanid. Tuberc Respir Dis (Seoul) 2024; 87:206-208. [PMID: 38111099 PMCID: PMC10990615 DOI: 10.4046/trd.2023.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023] Open
Affiliation(s)
- Oki Nugraha Putra
- Department of Clinical and Community Pharmacy, Study Program of Pharmacy, Faculty of Medicine, Hang Tuah University, Surabaya, Indonesia
| | - Telly Purnamasari
- Pre-Clinical and Clinical Studies, National Research and Innovation Agency, Central Jakarta, Indonesia
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Fang WJ, Tang SN, Liang RY, Zheng QT, Yao DQ, Hu JX, Song M, Zheng GP, Rosenthal A, Tartakovsky M, Lu PX, Wáng YXJ. Differences in pulmonary nodular consolidation and pulmonary cavity among drug-sensitive, rifampicin-resistant and multi-drug resistant tuberculosis patients: the Guangzhou computerized tomography study. Quant Imaging Med Surg 2024; 14:1010-1021. [PMID: 38223080 PMCID: PMC10783999 DOI: 10.21037/qims-23-694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/28/2023] [Indexed: 01/16/2024]
Abstract
Background Pulmonary nodular consolidation (PN) and pulmonary cavity (PC) may represent the two most promising imaging signs in differentiating multidrug-resistant (MDR)-pulmonary tuberculosis (PTB) from drug-sensitive (DS)-PTB. However, there have been concerns that literature described radiological feature differences between DS-PTB and MDR-PTB were confounded by that MDR-PTB cases tend to have a longer history. This study seeks to further clarify this point. Methods All cases were from the Guangzhou Chest Hospital, Guangzhou, China. We retrieved data of consecutive new MDR cases [n=46, inclusive of rifampicin-resistant (RR) cases] treated during the period of July 2020 and December 2021, and according to the electronic case archiving system records, the main PTB-related symptoms/signs history was ≤3 months till the first computed tomography (CT) scan in Guangzhou Chest Hospital was taken. To pair the MDR-PTB cases with assumed equal disease history length, we additionally retrieved data of 46 cases of DS-PTB patients. Twenty-two of the DS patients and 30 of the MDR patients were from rural communities. The first CT in Guangzhou Chest Hospital was analysed in this study. When the CT was taken, most cases had anti-TB drug treatment for less than 2 weeks, and none had been treated for more than 3 weeks. Results Apparent CT signs associated with chronicity were noted in 10 cases in the DS group (10/46) and 9 cases in the MDR group (10/46). Thus, the overall disease history would have been longer than the assumed <3 months. Still, the history length difference between DS patients and MDR patients in the current study might not be substantial. The lung volume involvement was 11.3%±8.3% for DS cases and 8.4%±6.6% for MDR cases (P=0.022). There was no statistical difference between DS cases and MDR cases both in PN prevalence and in PC prevalence. For positive cases, MDR cases had more PN number (mean of positive cases: 2.63 vs. 2.28, P=0.38) and PC number (mean of positive cases: 2.14 vs. 1.38, P=0.001) than DS cases. Receiver operating characteristic curve analysis shows, PN ≥4 and PC ≥3 had a specificity of 86% (sensitivity 25%) and 93% (sensitivity 36%), respectively, in suggesting the patient being a MDR cases. Conclusions A combination of PN and PC features allows statistical separation of DS and MDR cases.
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Affiliation(s)
- Wei-Jun Fang
- Department of Radiology, Guangzhou Chest Hospital, State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Sheng-Nan Tang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Rui-Yun Liang
- Department of Radiology, Guangzhou Chest Hospital, State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Qiu-Ting Zheng
- Department of Medical Imaging, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Dian-Qi Yao
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Jin-Xing Hu
- Department of Tuberculosis, Guangzhou Chest Hospital, State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Min Song
- Department of Radiology, Guangzhou Chest Hospital, State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Guang-Ping Zheng
- Department of Radiology, The Third People’s Hospital of Shenzhen, Shenzhen, China
| | - Alex Rosenthal
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Michael Tartakovsky
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Pu-Xuan Lu
- Department of Medical Imaging, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
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Sinulingga HE, Sinaga BYM, Siagian P, Ashar T. Profile and risk factors of pre-XDR-TB and XDR-TB patients in a national reference hospital for Sumatra region of Indonesia. NARRA J 2023; 3:e407. [PMID: 38455612 PMCID: PMC10919437 DOI: 10.52225/narra.v3i3.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/06/2023] [Indexed: 03/09/2024]
Abstract
The low treatment rate, low treatment success rate and high mortality rate of patients with pre-extensively drug-resistant tuberculosis (pre-XDR-TB) and extensively drug-resistant TB (XDR-TB) need serious attention. The aim of this study was to describe the profiles of patients with pre-XDR-TB and XDR-TB cases and to determine associated risk factors of their incidence in Indonesia. A retrospective case-control study was conducted at H. Adam Malik General Hospital in Medan, North Sumatra of which all sensitive-drug TB (SD-TB), pre-XDR-TB, and XDR-TB patients aged 18 years or older treated between October 2019 to June 2022 were included. Chi-squared test or Kruskal Wallis test and multiple logistic regression were used to determine the risk factors associated with pre-XDR-TB and XDR-TB incidence. A total 16 patients of case group (15 pre-XDR-TB and one XDR-TB) and 116 SD-TB patients (control group) were included in the final analysis. Out of total patients within case group, 62.5% were male, 43.8% aged between 56-65 years, 62.5% graduated from high school or equivalent, and 25% were unemployed. The majority of patients had no comorbid (62.5%), had history of anti-TB treatment (93.8%), and had secondary resistance (93.8%). Multivariate analysis indicated that age (OR: 10.01; 95%CI: 1.49- 66.91, p=0.018) and previous history of anti-TB treatment (OR: 216.25; 95%CI: 18.62- 2511.60, p<0.001) were significantly associated with incidence of pre-XDR-TB and XDR-TB. This study highlights that having previous history of anti-TB treatment and older age are the predictors of the incidence of pre-XDR-TB and XDR-TB.
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Affiliation(s)
- Herison E. Sinulingga
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
- Department of Pulmonology and Respiratory Medicine, H. Adam Malik General Hospital, Medan, Indonesia
| | - Bintang YM. Sinaga
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
- Department of Pulmonology and Respiratory Medicine, H. Adam Malik General Hospital, Medan, Indonesia
| | - Parluhutan Siagian
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
- Department of Pulmonology and Respiratory Medicine, H. Adam Malik General Hospital, Medan, Indonesia
| | - Taufik Ashar
- Department of Environmental Health, Faculty of Public Health, Universitas Sumatera Utara, Medan, Indonesia
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Omona K, Opiyo AM. Assessment of risk factors associated with multi-drug resistant tuberculosis (MDR-TB) in Gulu regional referral hospital. Afr Health Sci 2023; 23:343-357. [PMID: 38357137 PMCID: PMC10862605 DOI: 10.4314/ahs.v23i3.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background Multi-drug resistant tuberculosis (MDR-TB) is increasingly recognized as emerging infectious disease of public health concern. Globally, 206030 people were diagnosed with MDR-TB in 2019, representing a 10% increase from 186883people who had it in 2018. In Uganda, the prevalence of MDR among new TB cases is 4.4% and 17.7% among previously treated TB cases. Aim To determine the risk factors associated with MDR-TB among tuberculosis patients in Gulu regional referral hospital. Material and Methods A cross-sectional analytical study using both quantitative and qualitative methods of data collection and analysis was used. Data was collected from 384 TB patients using data extraction form and 6 Key informant interviews conducted. Analysis using Pearson chi-square test was run. Results HIV positive patients were 2.6 times more likely to be infected with MDR-TB than HIV negative patients [AOR=2.6: 95% CI 1.34- 5.85: P=0.006]. Previously treated TB patients were 2.8 times more likely to be infected with MDR-TB than newly diagnosed TB patients [AOR=2.8: 95% CI 1.33- 5.85: P=0.006]. Defaulting TB patients were 3.1 times more likely to be infected with MDR-TB than the non-defaulting TB patients [AOR=3.1]. Conclusion There is high prevalence of drug resistance among patients attending TB treatment at the facility.
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Affiliation(s)
- Kizito Omona
- Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
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Circular RNAs and tuberculosis infection. Int J Biol Macromol 2023; 226:1218-1225. [PMID: 36442574 DOI: 10.1016/j.ijbiomac.2022.11.235] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/13/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
Abstract
Tuberculosis (TB) is a deadly infectious disease caused by Mycobacterium tuberculosis (Mtb) that affects the immune system chronically. Therefore, effective control and treatment of tuberculosis requires rapid and accurate diagnostic strategies. Tuberculosis has always been a global burden on health, social and economic systems due to the lack of standard curative and diagnostic (bio)markers. Accordingly, the management and monitoring of patients with active TB at the primary care level may be possible through new, rapid and cost-effective non-sputum-based diagnostic procedures. Biomarkers can help diagnose various diseases, including circular RNA (circRNA), which has recently been introduced as an endogenous, abundant and stable RNA in the cytoplasm with unique tissue specificity. There are frequent reports of circRNA involvement in many pathological and physiological processes in human beings. Recent studies have highlighted the presence of circRNAs in serum and their role as promising biomarkers in the diagnosis of the disease, potentially due to the continuous, stable, closed covalent circular structures and lack of easy degradation by nucleases. The purpose of this review article is to scrutinize the behavior of circulating plasma RNAs in relation to the pathogenesis and diagnosis of tuberculosis.
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First and Second-Line Anti-Tuberculosis Drug-Resistance Patterns in Pulmonary Tuberculosis Patients in Zambia. Antibiotics (Basel) 2023; 12:antibiotics12010166. [PMID: 36671366 PMCID: PMC9855139 DOI: 10.3390/antibiotics12010166] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Drug-resistant tuberculosis has continued to be a serious global health threat defined by complexity as well as higher morbidity and mortality wherever it occurs, Zambia included. However, the paucity of information on drug-susceptibility patterns of both first-line and second-line anti-tuberculosis (anti-TB) drugs, including the new and repurposed drugs used in the management of drug-resistant tuberculosis in Zambia, was the major thrust for conducting this study. METHODS A total of 132 bacteriologically confirmed TB isolates were collected from patients with pulmonary TB during the period from April 2020 to December 2021 in Southern and Eastern Provinces of Zambia. Drug-resistance profiles were determined according to four first-line and five second-line anti-TB drugs. Standard mycobacteriological methods were used to isolate and determine phenotypic drug susceptibility. Data on the participants' social-demographic characteristics were obtained using a pre-test checklist. RESULTS Overall, the prevalence of resistance to one or more anti-TB drugs was 23.5% (31/132, 95% CI: 16.5-31.6%). A total of 9.8% (13/132, 95% CI: 5.3-16.2%) of the patients had multidrug-resistant TB and 1.2% were new cases, while 25.5% had a history of being previously treated for TB. Among those with mono-resistant TB strains, isoniazid (INH) resistance was the highest at 9.8% (13/132, 95% CI: 5.3-16.2%). Two (2/31) (6.5%) XDR-TB and one (1/31) (3.2%) pre-XDR-TB cases were identified among the MDR-TB patients. Previously treated patients were 40 times more likely (OR; 40.3, 95% CI: 11.1-146.5%) to have drug-resistant TB than those who had no history of being treated for TB. CONCLUSION This study has established a high rate of multidrug-resistant TB and has further identified both pre-XDR- and XDR-TB. There is a need to intensify surveillance of MDR- and XDR-TB to inform future guidelines for effective treatment and monitoring.
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Bykov I, Dyachenko O, Ratmanov P, Liu H, Liang L, Wu Q. Factors contributing to the high prevalence of multidrug-resistance/Rifampicin-resistance in patients with tuberculosis: an epidemiological cross sectional and qualitative study from Khabarovsk krai region of Russia. BMC Infect Dis 2022; 22:612. [PMID: 35831812 PMCID: PMC9281178 DOI: 10.1186/s12879-022-07598-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background Growing prevalence of multidrug-resistant/Rifampicin-resistant tuberculosis (MDR/RR-TB; resistance to Isoniazid and Rifampicin/Isolated resistance to Rifampicin) is putting in jeopardy the WHO End TB strategy. This study aimed to identify factors contributing to the high prevalence of MDR/RR-TB in Khabarovsk krai region of Russia. Methods A cross-sectional retrospective study was conducted, analyzing clinical, demographic, and drug susceptibility testing data on 1440 patients. As a source of raw data, the national electronic TB surveillance system was used. Anonymous data was collected on every patient diagnosed with TB in all healthcare facilities of the region from January 2018 to December 2019. Only patients with proven excretion of m. tuberculosis were included in the study. Factors associated with MDR/RR-TB were identified through logistic regression analysis, in conjunction with in-depth interviews with eight patients, five healthcare managers and five doctors. Findings 2661 patients were identified with TB, 1440 were incorporated in the study based on inclusion criteria. Of these, 618 (42.9%) were identified with MDR/RR-TB. Patients with a history of imprisonment were 16.53 times (95% CI 5.37 to 50.88,) more likely to have MDR/RR-TB, whereas re-treatment patients were 2.82 times (95% CI 2.16 to 3.66) more likely to have MDR/RR-TB. Other influencing factors included presence of disability (AOR is 2.32, 95% CI 1.38 to 3.89), cavitary disease (AOR is 1.76, 95% CI 1.37 to 2.25), and retirement status (AOR 0.65, 95% CI 0.43 to 0.98, p = 0.042). Poor patient knowledge and understanding of the disease, progressive weariness of prolonged TB treatment, and inability hospitalize infectious patients without their consent were perceived by the interviewees as major influencing factors. Conclusions Incarceration and treatment history, regardless of outcome, were identified as major factors influencing MDR/RR-TB prevalence. It is essential for the TB care system to eliminate legal loopholes, which deprive doctors of means to enforce quarantine procedures and epidemiological surveillance on infected patients, former and current inmates. Increasing people’s awareness of TB, early detection and appropriate treatment of patients with TB are needed for successfully combating MDR/RR-TB.
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Affiliation(s)
- Ilia Bykov
- Health Management College, Social Medicine Department, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 10081, People's Republic of China.,Public Health and Health Care Department, Far Eastern State Medical University, Khabarovsk, Russia
| | - Olga Dyachenko
- Internal Diseases Department with the Course of Phthisiology, Far Eastern State Medical University, Khabarovsk, Russia
| | - Pavel Ratmanov
- Public Health and Health Care Department, Far Eastern State Medical University, Khabarovsk, Russia
| | - Huan Liu
- Health Management College, Social Medicine Department, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 10081, People's Republic of China
| | - Libo Liang
- Health Management College, Social Medicine Department, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 10081, People's Republic of China
| | - Qunhong Wu
- Health Management College, Social Medicine Department, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 10081, People's Republic of China.
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Risk Factors and Treatment Outcome Analysis Associated with Second-Line Drug-Resistant Tuberculosis. JOURNAL OF RESPIRATION 2021. [DOI: 10.3390/jor2010001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The present study aimed at analyzing the treatment outcomes and risk factors associated with fluoroquinolone drug resistance having mutations in the gyrA and gyrB genes. A total of 258 pulmonary tuberculosis samples with first-line drug-resistant (H, R, or HR) were subjected to GenoType MTBDRsl assay for the molecular detection of mutations. Among the 258 samples, 251 were drug-resistant tuberculosis and seven were sensitive to all first-line TB drugs. Out of 251 DR-TB cases, 42 cases were MDR TB, 200 were INH mono-resistant and nine cases were RIF mono-resistant tuberculosis. Out of 251 DR-TB cases performed with a MTBDRsl assay, 14 had Pre-XDR-FQ, one patient had pre-XDR-SLID, one had extensively drug-resistant tuberculosis (XDR-TB) and 235 cases were sensitive to both FQ and SLID drugs. The study group had a mean average of 42.7 ± 16.4 years. The overall successful treatment outcomes among the MDR, INH mono-resistant, and pre-XRD patients were 70.6%, 82.0%, and 51%, respectively. The percentage of risk for the unfavorable outcomes in the pre-XDR, INH -mono-resistant, and XDR cases were 113.84% increased risk with RR 2.14; 95% CI 0.7821–5.8468. The independent risk factor associated with the unfavorable outcomes to failure was 77.78% increased risk with RR 1.78; 95% CI 0.3375–9.3655. Logistic regression analysis revealed that the percentage relative risk among MDR-TB patients for gender, male (RR: 1.85), age ≥ 61 years (RR: 1.96), and diabetics (RR: 1.05) were 84.62%, 95.83%, and 4.76%, respectively. The independent risk factors associated with INH mono-resistant cases of age 16–60 (RR: 1.86), ≥61 year (RR: 1.18), and treated cases (RR: 5.06). This study presaged the significant risk of INH mono-resistant, pre-XDR, and MDR among males, young adults, diabetics, and patients with previous treatment failure. Timely identification of high-risk patients will give pronounced advantages to control drug resistance tuberculosis diseases.
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Hajissa K, Marzan M, Idriss MI, Islam MA. Prevalence of Drug-Resistant Tuberculosis in Sudan: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2021; 10:antibiotics10080932. [PMID: 34438982 PMCID: PMC8388945 DOI: 10.3390/antibiotics10080932] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
Drug-resistant tuberculosis (DR-TB) is still one of the most critical issues impeding worldwide TB control efforts. The aim of this systematic review and meta-analysis was to give an updated picture of the prevalence of DR-TB in Sudan. A comprehensive systematic search was performed on four electronic databases (PubMed, Scopus, Web of Science and Google Scholar) to identify all published studies reporting prevalence data of DR-TB in Sudan. Sixteen eligible studies published during 2002-2020 were included. Using meta-analysis of proportions, the pooled prevalence of TB cases with resistance to any anti-TB drugs was 47.0% (95% CI: 35.5-58.6%). The overall prevalence of mono, multi, poly and extensive drug resistance were estimated to be 16.2% (95% CI: 9.0-23.4%), 22.8% (95% CI: 16.0-29.7%), 6.8% (95% CI: 0.5-13.0%) and 0.7% (95% CI: 0-2.1%), respectively. Considering any first-line anti-TB drugs, the resistance prevalence was highest for isoniazid (32.3%) and streptomycin (31.7%), followed by rifampicin (29.2%). In contrast, resistance against second-line drugs was reported for only two antibiotics, namely, ofloxacin (2.1%) and kanamycin (0.7%). Of note, the resistance profile of the previously treated patients was found to be remarkably high compared with the newly diagnosed TB patients. The relatively high prevalence estimation of anti-TB drug resistance warrants strengthening TB control and treatment strategies in Sudan.
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Affiliation(s)
- Khalid Hajissa
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
- Department of Zoology, Faculty of Science and Technology, Omdurman Islamic University, P.O. Box 382, Omdurman 14415, Sudan
| | - Mahfuza Marzan
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh;
| | | | - Md Asiful Islam
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: or
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