Multi drug resistance tuberculosis: pattern seen in last 13 years

Drug resistance in tuberculosis is a serious problem throughout the world especially, after the emergence of multi drug resistant TB strains. To estimate drug resistance in TB patients and compare it with previous studies to see the changing trends. The PMRC Research Centre receives sputum samples from all the leading hospitals of Lahore. This retrospective analysis was done from 1996 to 2008 on the multi drug resistant TB strains that were seen during these years. Five first lines tuberculosis drugs were tested on Lowenstein Jensen medium using standard proportion method. A total of 2661 confirmed isolates of Mycobacterium tuberculosis were seen over the past 13 years. Of the total, 2182 were pulmonary and 479 were extra pulmonary specimens. The patients comprised of those with and without history of previous treatment. These specimens were subjected to drug susceptibility testing. Almost half of the patient had some resistance; multiple drug resistance were seen in 12.3% and 23.0% cases without and with history of previous treatment respectively. overall resistance to rifampicin was 26.4%, isoniazid 24.1% streptomycin 21.6% ethambutol 13.4% and pyrazinamide 28.4% respectively. Statistically significant difference was seen between primary and acquired resistance. When compared with the reports from previous studies from the same area, there was a trend a gradual increase of drug resistance. Resistance to anti tuberculosis drugs in high. TB Control Program should start "DOTS Plus" schemes for which drug susceptibility testing facilities should be available for correctly managing the patients

Extra pulmonary tuberculosis: an experience at Mayo hospital Lahore

To study the site and culture positivity of extra pulmonary specimens received from year 2000 to 2005. The work was done at the PMRC TB Research center, Mayo hospital Lahore. The centre receives specimens from all the leading hospitals of Lahore. A total of 2476 extra pulmonary specimens subjected for TB culture by standard proportion method and were analyzed. Majority [84.37%] of specimens received were rom pulmonary site while 15.6% were from extra pulmonary site. Overall culture positivity yield was 19.5%. Of the samples received majority [24.3%] were pleural fluid, followed by in descending order of frequency were 16% bronchial washing, 15.5% from genitourinary tract, 14.1% lymph nodes, 2.6% gastric aspirate, 2.5% endometrial,1.5% bone and 1.2% [CSF]. The culture positivity of these specimens were 24.3% for pleural, 16% bronchial, 24.87% genitourinary, 34.18% lymph nodes, 6% gastric aspirate, 4.5% endometrial,13.5% bone and 3.2% CSF. Extra pulmonary tuberculosis remains an important infectious disease, with commonest form being tuberculous lymphadenitis and genital tuberculosis. Physicians and health care providers should keep the diagnosis of tuberculosis high on priority and make efforts in prompt and efficient diagnosis and treatment