El dilema en los laboratorios de Koch, ¿Cultivar o no Cultivar? / The Dilemma in Koch's Laboratories, To Cultivate or Not to Cultivate?

La nueva norma técnica para el control y la eliminación de la tuberculosis es un gran avance para el diagnóstico de este microorganismo en Chile. Actualmente la principal técnica microbiológica para el diagnóstico de laboratorio es la biología molecular, que reduce el tiempo del resultado a tan solo un par de horas. La normativa actual indica que en el paciente caso presuntivo de tuberculosis (CPT) la técnica exclusiva a realizar es Biología molecular. La literatura indica que la detección a través de amplificación de material genético de la micobacteria tiene un límite de detección de 15,6 UFC/ ml, por tanto, todas las muestras bajo ese límite umbral potencialmente podrían no ser diagnosticadas bajo esta estructura emanada por el ministerio de Salud en Chile. Nuestra recomendación es continuar con el estudio de cultivo en medios líquidos o sólidos para todas las muestras hasta obtener literatura que avale lo contrario

The new technical standard for the control and elimination of tuberculosis in Chile is a great advance for the diagnosis of this microorganism. Currently the main microbiological technique for laboratory diagnosis is PCR, which reduces the time to result to just a couple of hours. The current regulations indicate that in the patient with a presumptive case of tuberculosis (CPT) t he exclusive technique to be performed is PCR. The literature indicates that the detection through amplification of genetic material of the mycobacterium has a detection limit of 15.6 CFU/ml, therefore, all samples under this threshold limit could potentially not be diagnosed under this structure emanated by the Ministry of Health in Chile. Our recommendation is to continue with the study of culture in liquid or solid media for all samples until literature confirms otherwise

Prevalence of Rifampicin Resistance Tuberculosis in Newly Diagnosed and Previously Treated Pulmonary Tuberculosis Patients Attending the Department of Pulmonary Medicine , Muzaffarnagar Medical College, Muzaffarnagar

Background: Multidrug-resistant tuberculosis (MDR-TB) prevalence is increasing throughout the world. Although, most important risk factor for development of MDR-TB is inadequate and irregular previous treatment for tuberculosis, but newly treated patients are also at risk due to either spontaneous mutations or transmission of drug-resistant strains. The conventional tuberculosis drug susceptibility tests are sensitive and specific but they are not rapid. Newer molecular methods help in rapid diagnosis. GeneXpert MTB/RIF is a rapid method to detect MTB and rifampicin resistance. Rifampicin resistance is an initial indicator of multidrug resistance. We have tried to ascertain the prevalence of Rifampicin resistance in newly diagnosed and previously treated pulmonary tuberculosis patients. Methods: This study was a prospective cross sectional study that involved all newly diagnosed and previously treated pulmonary tuberculosis patients attending the Department of Pulmonary Medicine, Muzaffarnagar Medical College, Muzaffarnagar from January 2018 to Dec 2018. In the District Hospital, Muzaffarnagar,the sputum specimens were sent for GeneXpert MTB/RIF .On the basis of the result, the patients were labelled as Rifampicin resistance. Results: A total no of 118 sputum samples were sent to District Hospital,Muzaffarnagar for GeneXpert MTB/RIF . Among these 118 patients, 102 patients were newly diagnosed pulmonary tuberculosis and 16 patients were previously treated pulmonary tuberculosis . Prevalence of Rifampicin resistance TB was found to be 0.98 % among newly diagnosed pulmonary tuberculosis, and 25 % among previously treated pulmonary tuberculosis patients. Conclusion: In conclusion, our results showed that the prevalence of Rifampicin resistance TB was high in previously treated pulmonary tuberculosis patient in comparison to newly diagnosed pulmonary tuberculosis patient. Proper administration of first line drugs for susceptible cases is most efficient method in preventing drug resistance.

Prevalencia de la resistencia de Mycobacterium tuberculosis a quinolonas y fármacos inyectables en Colombia, 2012-2013 / Prevalence of Mycobacterium tuberculosis resistance to quinolones and injectables in Colombia, 2012-2013

Resumen Introducción: La tuberculosis es un problema de salud pública a nivel mundial. En 2014, la Organización Mundial de la Salud estimó que se habían presentado 9,6 millones de casos nuevos y 480.000 multirresistentes. La evaluación de la resistencia a fármacos inyectables y a quinolonas se introdujo hace pocos años, por lo cual no se conoce su prevalencia. Objetivo: Determinar la prevalencia de la resistencia a amicacina, kanamicina, capreomicina y ofloxacina en casos de tuberculosis resistente a isoniacida, rifampicina o a ambas, entre 2012 y 2013. Materiales y métodos: Se hizo un estudio de corte transversal con 489 aislamientos resistentes a isoniacida o rifampicina. Las pruebas de sensibilidad se hicieron con la técnica Bactec MGITTM. Para el análisis de la proporción de la resistencia, los casos se agruparon según el antecedente de tratamiento con medicamentos de segunda línea. Resultados: En los 438 casos nuevos, la resistencia global a la kanamicina fue mayor (7,1 %; IC95% 4,6-9,6); en los 51 casos previamente tratados, dicha resistencia fue de 27,5 % (IC95% 14,2-40,7). La resistencia global fue mayor en casos con antecedentes de tratamiento con quinolonas y fármacos inyectables. Se encontraron siete casos de tuberculosis extremadamente resistente. Conclusión: El estudio evidenció la presencia de resistencia a fármacos de segunda línea en personas con tuberculosis farmacorresistente sin tratamiento previo o tratadas previamente con quinolonas o fármacos inyectables, estos últimos con mayor porcentaje de resistencia. En consecuencia, es esencial practicar rutinariamente las pruebas de sensibilidad y el análisis de esta información.

Abstract Introduction: Tuberculosis is a health problem worldwide. The World Health Organization estimated 9.6 million new cases and 480,000 multirresistant cases for 2014. The assessment of resistance to quinolones and injectables was implemented only a few years ago, so its prevalence is not known. Objective: To determine the prevalence of resistance to amikacin, capreomycin and ofloxacin in cases of tuberculosis resistant to isoniazid and/or rifampin during 2012-2013. Materials and methods: This was a cross-sectional study of 489 isolates resistant to isoniazid and/or rifampin. We used the Bactec MGITTM technique for susceptibility tests. For analyzing the rate of resistance, we grouped cases according to the history of treatment with second line drugs. Results: In the 438 new cases, the drug that showed greater overall resistance was kanamycin with 7.1 % (95% CI: 4.6 to 9.6). In 51 previously treated cases, this highest resistance was 27.5 % (95% CI: 14.2 to 40.7). The overall resistance was higher in cases with a history of treatment with quinolones and injectables. We found seven cases of extremely resistant tuberculosis. Conclusion: This study demonstrates the presence of resistance to second line drugs in people with drug-resistant tuberculosis with and without previous treatment with quinolones and/or injectables, these latter having a higher percentage of resistance. For that reason, it is essential to perform susceptibility testing and analyze this information routinely.

Comparative antimycobacterial activity of some Indonesian medicinal plants against multi-drug resistant Mycobacterium tuberculosis.

This study has been carried out to compare antimycobacterial activity of five selected Indonesian endogenous medicinal plants of Andrographis paniculata, Annona muricata, Centella asiatica, Pluchea indica, and Rhoeo spathacea against clinical isolate of multi-drug resistant (MDR) Mycobacterium tuberculosis. The aqueous extracts of leaves of Andrographis paniculata, Annona muricata, Centella asiatica, Pluchea indica, and Rhoeo spathacea were obtained by maceration, and the phytochemical constituents of each extract were screened. Antimycobacterial activity of aqueous plant extracts were determined by proportion methods using Lowenstein Jensen (L-J) medium. Our study exhibited that all extracts of five selected plants showed inhibited activity against Mycobacterium tuberculosis H37Rv strain and multi drug resistant (MDR) strain. The proportion inhibition of aqueous extract of Andrographis paniculata, Annona muricata, Centella asiatica, Pluchea indica, and Rhoeo spathacea, against Mycobacterium tuberculosis H37Rv strain were 100%, 82.1%, 78.5%, 100%, and 100% respectively, whereas against MDR strain were 93.7%, 50.0%, 50.0%, 100%, and 100% respectively. The phytochemical analysis showed that the extracts were predominantly contains flavonoids, alkaloids, saponins, tannins and glycosides. Pluchea indica, and Rhoeo spathacea showed good antimycobacterial activity against MDR strains and could be useful as complementary alternative therapy in combating the emergence of MDR strains of Mycobacterium tuberculosis.

Drug resistance pattern of Mycobacterium tuberculosis isolates from patients of five provinces of Iran

OBJECTIVE@#To determine the patterns of resistance to first line anti-tuberculosis (TB) drugs among a collection of Mycobacterium tuberculosis (MTB) isolates from 5 provinces of Iran.@*METHODS@#A total of the 6 426 clinical specimens from patients suspected of active TB were collected from March 2010 to June 2012. All specimens were subjected for microscopy and culture tests in the TB centers of studies provinces. Drug susceptibility testing to the first line anti-TB drugs for culture positive MTB was performed on Löwenstein-Jensen (LJ) medium using proportion method.@*RESULTS@#Of 6 426 clinical specimens, 261 were culture positive for mycobacteria, of which 252 were MTB and 9 were MOTT (mycobacteria other than tuberculosis). Of 252 MTB isolates, 211 (83.7%) were pan-susceptible and 41 (16.3%) were resistant to at least one drug. Resistance was most common to streptomycin, 30 isolates (12.0%), followed by isoniazid, 20 isolates (8.0%), rifampin, 15 isolates (6.0%) and ethambutol, 14 isolates (5.5%). Sixteen (6.3%) MTB isolates were MDR. A clear evidence of heterogeneity amongst the 5 provinces in the proportions with resistance to one or more drugs was observed [χ(2); = 12.209 (4 degrees of freedom), P values = 0.015 9].@*CONCLUSIONS@#The prevalence of drug resistance in this study area underscoring the need for further enforcement of TB control strategies in the Iran. Drug susceptibility testing for all TB cases to provide optimal treatment, establishing advanced diagnostic facilities for rapid detection of MDR-TB and continuous monitoring of drug resistance are recommended for prevention and control of drug-resistant TB.

Empyema necessitatis complicated to paravertebral abscess – A rare case of primary multidrug resistance tuberculosis.

Primary MDR tuberculosis still very rare 3% approx. in India , here we describe the case of 26 year old male having right sided loculated tuberculous empyema,that complicated to empyema nessacitatis and later spread to paraverteveral region, spleen , and omental lymph node proved to be resistance to rifampicin and isoniazid. [