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Objective To analyze the disease burden of multidrug-resistant tuberculosis (MDR-TB) in China and regions with different income levels in the world from 1990 to 2019. Methods Using the Global Burden of Disease Study 2019 (GBD2019) results, the changes of the disease burden of MDR-TB in China and regions with different income levels in the world were described and analyzed using the Joinpoint Regression Program 4.8.0.1 software. Results From 1990 to 2019, the age standardized incidence, mortality and DALY rates in China and other areas with different income levels in the world basically showed a trend of first rising and then decreasing at the turning point of the late 20th century and early 21st century, except for low-income areas where the age standardized incidence rate showed an overall upward trend. In 2019, the incidence rate, mortality and DALY rate of MDR-TB in China were 9 times, 6.67 times and 6.89 times higher than those in high-income areas, respectively. The incidence rate in China was 6 times lower than that in low and middle-income areas, while the mortality and DALY rate in China were 26 times and 32.53 times lower than those in low-income areas, respectively. The age standardized incidence, mortality rate and DALY rate of MDR-TB in men were higher than those in women. Risk factors for the burden of MDR-TB disease included alcohol consumption, smoking, and high fasting blood glucose. Conclusion From 1990 to 2019, there are significant regional and gender differences in the disease burden of multidrug-resistant tuberculosis in China and regions with different income levels in the world. Multidrug-resistant tuberculosis is still a major challenge for tuberculosis control in the world. It is necessary to develop more effective control strategies and health care systems to deal with multidrug-resistant tuberculosis.
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Objective: Resistance against Mycobacterium tuberculosis (MTB) is important in the sense that it has an implication in the control of tuberculosis. The terms used to describe resistance to antituberculosis drugs are resistance among new cases (or primary resistance) and resistance among previously treated patients. The resistance among previously treated patients may be due to faulty treatment like prescription of inadequate treatment regimens, interrupted availability or poor quality of drugs, or incomplete treatment adherence while subsequent transmission of these resistant organisms to others will lead to development of disease which is resistant from the beginning called primary resistance. Pakistan is ranked eighth in terms of global estimated burden of tuberculosis cases. Multi-Drug Resistant (MDR) tuberculosis among new cases and MDR among previously treated patients is 3.2% and 35% respectively. Material and methods: - AFB smear examination and grading: - AFB smear examination was carried out by direct microscopy using the Ziehl Neelsen (ZN) method. Sputum smear result was examined and interpreted according to the AFB grading. AFB culture and drug susceptibility test: - Culture examinations were done on all diagnostic specimens of AFB smear positivity. Sputum specimens from each patient were processed with sodium hydroxide (NaOH) method-Modi?ed Petroff 's procedure and cultured on Lowenstein-Jensen (LJ) slopes.10 All inoculated LJ drug and control media were incubated at 37ºC. All cultures were examined 48-72 hours after inoculation to detect gross contaminants. Thereafter, cultures were examined weekly, up to eight weeks on a speci?ed day of the week. Typical colonies of M. tuberculosis were rough, crumbly, waxy, non-pigmented (buff coloured) and slow-growers, i.e., only appeared two to three weeks after inoculation. The colony was con?rmed by ZN staining. Detection time for MOTT was 25 days. M. tuberculosis positive strains were culture negative when they grew on p-nitro benzoate (PNB) containing medium. Only a few colonies of non-tuberculosis Mycobacteria (NTM – often pigmented, with smooth morphology or PNB positive) were grown as visible colonies on PNB containing medium. Anti-TB drug susceptibility testing: - anti-susceptibility testing perform on pre-formed LJ media with antitubercular drugs Tuberculosis First Line Kit (Total 7 slants) Containing ?ve antitubercular agent (Isoniazid, Streptomycin, Ethambutol, Rifampicin and Pyrazinamide) 2 controls without any antimicrobial agent. Results: out of 119 samples antitubercular testing against ?rst line antitubercular drugs such as Pyrazinamide were shows 12 (10.08%) sample were resistance which accounts maximum resistance among ?rst line antitubercular another ?rst line antitubercular drugs shows resistance as follows Streptomycin (9.24%), Ethambutol (8.40%), Isoniazid (7.56%), Rifampicin (6.72%), drugs out of 119 samples in which 107 samples were susceptible to the Pyrazinamide drug in in-vitro antitubercular susceptibility testing. Antitubercular resistance against second line antitubercular drugs were shows as follows out of 119 samples antitubercular testing Ethionamide were shows 9 (8.18%) sample were resistance which accounts maximum resistance among second line antitubercular another second line antitubercular drugs shows resistance as follows Clarithromycin (6.72%), Cipro?oxacin (5.88%), D- Cycloserine (5.88%), Amikacin (5.04%), Kanamycin (4.20%), P- aminosalicylic acid ( 4.20%) and Rifabutin (3.36%) drugs out of 119 samples in which 107 samples were susceptible to the Pyrazinamide drug in in-vitro antitubercular susceptibility testing. MDR-TB emerged in patients who were resistant to Rifampicin and Isoniazide was 6 in number during this study.
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La emergencia de cepas resistentes de Mycobacterium tuberculosis a múltiples drogas, las dificultades de su diagnóstico y tratamiento constituyen un desafío a la salud pública mundial. Para afrontar esta situación, se emplean nuevas drogas antituberculosis, como bedaquilina, pretomanid y delamanid, así como drogas repropuestas, como fluoroquinolonas, linezolid y clofazimina. Con base en la evidencia brindada por estudios multicéntricos, se han descubierto fármacos asociados a un mejor pronóstico de la tuberculosis drogorresistente y, recientemente, se ha propuesto una nueva clasificación, así como nuevos esquemas totalmente orales. En esta revisión, describimos los esquemas de tratamiento actuales y los aspectos farmacológicos prácticos necesarios a la hora de la prescripción de los nuevos regímenes de tratamiento de la tuberculosis drogorresistente.
The emergence of resistant strains of Mycobacterium tuberculosis to multiple drugs and the difficulties of their diagnosis and treatment constitute a challenge to global public health. To face this challenge, new anti-tuberculosis drugs, such as bedaquiline, pretomanid, and delamanid, as well as replacement drugs, such as fluoroquinolones, linezolid and clofazimine, are used. Based on the evidence provided by multicenter studies, drugs associated with a better prognosis of drug-resistant tuberculosis have been discovered and, recently, a new classification has been proposed, as well as new totally oral regimens. In this review, we describe current treatment regimens and practi cal pharmacological aspects required when prescribing new drug-resistant tuberculosis treatment regimens.
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ABSTRACT The emergence of resistant strains of Mycobacterium tuberculosis to multiple drugs and the difficulties of their diagnosis and treatment constitute a challenge to global public health. To face this challenge, new anti-tuberculosis drugs, such as bedaquiline, pretomanid, and delamanid, as well as replacement drugs, such as fluoroquinolones, linezolid and clofazimine, are used. Based on the evidence provided by multicenter studies, drugs associated with a better prognosis of drug-resistant tuberculosis have been discovered and, recently, a new classification has been proposed, as well as new totally oral regimens. In this review, we describe current treatment regimens and practical pharmacological aspects required when prescribing new drug-resistant tuberculosis treatment regimens.
RESUMEN La emergencia de cepas resistentes de Mycobacterium tuberculosis a múltiples drogas, las dificultades de su diagnóstico y tratamiento constituyen un desafío a la salud pública mundial. Para afrontar esta situación, se emplean nuevas drogas antituberculosis, como bedaquilina, pretomanid y delamanid, así como drogas repropuestas, como fluoroquinolonas, linezolid y clofazimina. Con base en la evidencia brindada por estudios multicéntricos, se han descubierto fármacos asociados a un mejor pronóstico de la tuberculosis drogorresistente y, recientemente, se ha propuesto una nueva clasificación, así como nuevos esquemas totalmente orales. En esta revisión, describimos los esquemas de tratamiento actuales y los aspectos farmacológicos prácticos necesarios a la hora de la prescripción de los nuevos regímenes de tratamiento de la tuberculosis drogorresistente.
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BACKGROUND: Multi-drug resistant tuberculosis has become major public health problem and obstacle to effective control of tuberculosis. Over a period of time, there are several landmark achievements including policy and system preparedness for universal access to TB care including mandatory noti?cation of TB cases, development of standard for TB care in India, comprehensive real time TB information management system-NIKSHAY, use of rapid molecular diagnostics, successful innovations in private sector engagement for TB care-Universal access to TB care. Objective was to ?nd out the challenges in initiation of treatment of Multi Drug Resistant-TB patients get admitted in ITKI Sanatorium Ranchi Jharkhand. METHODS: It was a hospital based cross sectional study carried out from August 2016 to Nov.2018 on Multi drug resistant tuberculosis patients admitted in MDR-TB centre Itki Sanatorium Ranchi after approved from institutional ethics committee. Total study subjects included in study was 64. RESULTS: Most of the study subjects 58 (90.6%) did not know about the MDR-TB. Most of the study subjects 40 (62.5%) had been given reports of CB-NAAT test on same day followed by study subjects 24 (37.5%) on alternate day. No one study subjects 64 (100%) had been given any type of incentive for travelling to pretreatment evaluation centre. In above table, most of the patients 51 (79.7%) had made payment for investigations at district hospital/ SDH level followed by 13 (20.3%) who were free of any expenditure for investigations. Most of the study subjects 60 (93.7%) were not visited by any health staff between ?nal diagnosis of MDR-TB and initiation of treatment for MDR-TB followed by subjects 4 (6.3%) who were being visited by health staff. Most of the study subjects 48 (75%) were unaware about the NIKSHAY POSHAN SCHEME for MDR-TB patients followed by subjects 16 (25%) who knew about the NIKSHAY POSHAN SCHEME for MDR-TB patients by means of various medium.
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ABSTRACT Background: Rapid molecular methods such as the line probe assay (LPA) and Xpert® MTB/RIF assay (Xpert) have been recommended by the World Health Organization for drug-resistant tuberculosis (DR-TB) diagnosis. We conducted an interventional trial in DR-TB reference centers in Brazil to evaluate the impact of the use of LPA and Xpert. Methods: Patients with DR-TB were eligible if their drug susceptibility testing results were available to the treating physician at the time of consultation. The standard reference MGITTM 960 was compared with Xpert (arm 1) and LPA (arm 2). Effectiveness was considered as the start of the appropriate TB regimen that matched drug susceptibility testing (DST) and the proportions of culture conversion and favorable treatment outcomes after 6 months. Results: A higher rate of empirical treatment was observed with MGIT alone than with the Xpert assay (97.0% vs. 45.0%) and LPA (98.2% vs. 67.5%). Patients started appropriate TB treatment more quickly than those in the MGIT group (median 15.0 vs. 40.5 days; p<0.01) in arm 1. Compared to the MGIT group, culture conversion after 6 months was higher for Xpert in arm 1 (90.9% vs. 79.3%, p=0.39) and LPA in arm 2 (80.0% vs. 83.0%, p=0.81). Conclusions: In the Xpert arm, there was a significant reduction in days to the start of appropriate anti-TB treatment and a trend towards greater culture conversion in the sixth month.
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BACKGROUND Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis, and the number of new cases of multidrug resistant TB (MDR-TB), pre extensively drug-resistant TB (pre-XDR-TB) and extensively drug-resistant TB (XDR-TB) has increased considerably worldwide. OBJECTIVES Herein, using 156 M. tuberculosis isolates from 106 patients previously classified as MDR or pre-XDR or XDR isolates, we investigated the genetic mutation profiles associated with phenotypic resistances in patients with MDR-TB, pre-XDR-TB and XDR-TB, treatment outcomes and resistance evolution. METHODS Molecular analyses were performed by partial sequencing of the rpoB, katG, gyrA, gyrB, rrs genes and analysis of the fabG-inhA promoter region. Clinical, epidemiologic and demographic data were obtained from the TB Notification database system of São Paulo (TB-WEB) and the Information System for Special Tuberculosis Treatments (SITE-TB). FINDINGS Drug resistance was attributed to previously known mutations and a novel Asp449Val mutation in gyrB was observed in four isolates from the same patient. Ten patients had more than one isolate evaluated and eight of these patients displayed resistance progression. MAIN CONCLUSIONS The present study is the first to report the frequency of mutations related to second-line drug resistance in MDR-TB, pre-XDR-TB and XDR-TB isolates. The results could lead to the improvement of available technologies for the rapid detection of drug resistant TB.
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Humans , Male , Female , Adolescent , Adult , Young Adult , Tuberculosis, Multidrug-Resistant/microbiology , Drug Resistance, Multiple, Bacterial/genetics , Mutation/genetics , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/genetics , Antitubercular Agents/pharmacology , Socioeconomic Factors , Brazil , Microbial Sensitivity Tests , Extensively Drug-Resistant Tuberculosis/microbiology , Middle Aged , Mycobacterium tuberculosis/isolation & purificationABSTRACT
Background: The aims and objectives were to study the progression from tuberculosis to multi drug resistance-TB in revised national tuberculosis control programme: perspectives from health system care givers.Methods: The study was carried out in TB Sanatorium ITKI, Sadar Hospital Ranchi and RIMS Ranchi. The interview of various health personnel including SAHIYAs was taken using a semi-structured questionnaire based on programmatic management of multi drug resistant tuberculosis guidelines -2016.Results: Among Doctors knowledge level was good compared to other health personnel which had mean value 7.33 (±2.79), laboratory technician 3.45 (±2.64), STS 4.67 (±1.59), Sahiya 2.1 (±0.73). Regarding capacity enhancement level all health personnel needed refresher trainings in which doctors got 4.67 (±1.58), laboratory technician 3.45±2.64, STS 1.72±0.34, and Sahiya 0.5±0.52. Specially sahiya needs training regarding MDR-TB because they are the connecting link between health system and community. Regarding execution level, Doctors got 1.86 (±0.74), laboratory technician 1.64 (±0.56), STS 1.64 (±0.56) and Sahiya (ASHA) 2.2 (±0.44). Sahiya were better than other health personnel at execution level.Conclusions: Advocacy, communication, and social mobilization are important aspects of TB control, Policy makers and administrators should be sensitized for need of adequate and sustained funding for TB control to ensure quality capacity building. They need to provide continuous and quality training of staff at different levels and retention of trained staff and periodic reviews to identify gaps and take corrective steps.
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Background: Multidrug resistant tuberculosis (MDR-TB) has become a major public health problem. It is associated with significant morbidity and mortality. The treatment success rate worldwide is around 50%.Methods: This cross-sectional study was conducted on all MDR-TB patients who were registered and being treated under PMDT services in Amritsar district from 1st April 2014 to 31st March 2015. The treatment outcome with their socio-demographic determinants was ascertained. Data management and analysis was done by using Microsoft excel and SPSS.Results: Out of 87 MDR-TB patients, 57 (65.5%) were males and 30 (34.4%) were females. The various treatment outcomes observed were- 30 (34.5%) cured, 19 (21.8%) treatment completed, 18 (20.7%) died, 13 (14.9%) defaulted, 4 (4.6%) shifted to XDR TB regime and 3 (3.4%) failure.Conclusions: On statistical analysis, it was observed that age (p=0.000), marital status (p=0.024), educational status (p=0.011) and occupation (p=0.002) were significantly associated with the treatment outcome. Other factors like sex, type of family and socio-economic status did not affect the treatment outcome.
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Tuberculosis caused by Mycobacterium tuberculosis has remained a major global health problem worldwide. TB requires prolonged period of time for isolation by conventional culture methods. The emergence and spread of multi drug resistant (MDR-TB) poses great threats and challenges in controlling the infection. MDR-TB is resistant to both first line drugs rifampicin and isoniazid. PCR tests are based on targeting the mutation in rpoB, katG and inhA genes which can detect resistance to these drugs. To compare microscopy, conventional culture and Line probe assay for the detection of M. tuberculosis & detect rifampicin and isoniazid resistance using Lineprobe assay in various clinical samples. A total of 347 suspected patients of tuberculosis were included in the study. Demographic details & clinical presentation was noted. Various samples were received & processed for ZN staining, culture on LJ media and Line probe assay. Out of 347 cases, majority of cases were in the age group of 51-60 years (18.4%). Majority of the population was males (65.1%). Among suspected tuberculosis patients, cough with expectoration (55.9%) was the commonest complaint. Microscopy was positive in 17.3%, conventional culture was positive in 16.1% and line probe assay was positive in 26.2%. Out of 347, 91 were diagnosed with MTB, out of which 85.7% were sensitive to both rifampicin and isoniazid whereas 14.3% showed resistance to either rifampicin / isoniazid or both. LPA & direct microscopy are a good screening method for early diagnosis and detection of drug resistance but are not a complete replacement of conventional culture which is still a gold standard.
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Background: There were 4.1% of all new cases and 19% of previously treated patients were diagnosed with either multidrug resistant or rifampicin resistant tuberculosis in 2016. In the state of Uttar Pradesh, there were 2.16 new cases and 44,531 previously treated cases. The objectives of the study were to assess the predisposing factors, causality assessment, severity grading and avoidability of the adverse drug reactions (ADRs) of the antitubercular drugs in MDR-TB patients in a tertiary care hospital of northern India.Methods: This prospective observational study was conducted for 12 months at a tertiary care hospital. The patients with MDR tuberculosis on treatment with DOTS Plus regimen under RNTCP and who met the inclusion exclusion criteria were recruited after informed consent. ADRs were monitored daily till the patients remained admitted and thereafter monthly. Predisposing factors were recorded. Causality assessment was performed by Naranjo scale and WHO UMC scale, severity by Hartwig’s scale and avoidability by Halla’s scale.Results: There were 115 patients were recruited, 70 developed at least one ADR. 98 ADRs were reported. The commonest ADR reported were – gastrointestinal (38.76%), neurological (21.24%) and hepatobiliary (8.16%). Diabetes and HIV predisposed to development of ADRs. 58.18% ADRs were classified as possible and 37.5% as probable by Naranjo’s scale. 51.02% ADRs were classified as probable and 42.83% as possible by WHO-UMC. 56% were classified as mild, 36% moderate, and 6% severe via Hartwig’s scale. 51 ADRs were classified as avoidable and 40 ADRs were possibly avoidable.Conclusions: Monitoring and assessment of ADRs is necessary to promote awareness, curb resistance and maintain adherence.
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Background: Between 2006 and 2015, the prevalence of MDR-TB has been found to be as high as 39.9% in some states. Approximately 35.8% of all previously treated patients developed MDR-TB. The objective of the present study was to identify demographic and health characteristics of patients as well as incidence and pattern of the adverse drug reactions caused by antitubercular drugs in MDR-TB patients in a tertiary care hospital of northern India.Methods: This 12 months study of observational study was conducted at a DOTS centre. MDR-TB diagnosed patients treated with DOTS Plus regimen were enrolled after getting informed consent. Patient information was recorded. Patient follow-up was conducted to identify the incidence and pattern of ADRs.Results: A total of 115 patients were enrolled. Maximum number of cases were in the 31-40 age group (25.21%) followed by the 41-50 age group (20.86%). 76 (66.08%) were males and 39 (33.91%) were females. 52 patients (45.21%) had concomitant diseases, out of which 15 (13.04%) were HIV positive and 21 (18.26%) were diabetic. 70 patients (60.86%) developed ADRs. The adverse drug reaction that were seen are -38 (38.76%) cases of gastrointestinal adverse drug reactions, 8 (8.16%) jaundice/hepatitis, 7 (7.14%) impaired hearing/vertigo, 21 (21.24%) central nervous system adverse drug reaction, 6 (6.12%) peripheral neuropathy, 6 (6.12%) rash and itching, 5 (5.10%) arthralgia, 3 (3.06%) renal impairment, 2 (2.04%) hypothyroidism and 2 (2.04%) blurred vision.Conclusions: Determining which population groups are affected most by ADRs can help physicians to better monitor and make an early diagnosis to reduce ADR-related morbidity and mortality.
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Background: Despite availability of good quality anti-tubercular drugs and its administration through Directly Observed Therapy Short Course (DOTS) strategy of Revised National Tuberculosis Control Programme (RNTCP), tuberculosis remains a major cause of morbidity and mortality in India. The emergence of drug resistance necessitates the timely detection of susceptibility of anti-TB drugs. This can help in appropriate modification in treatment strategies.Methods: A total of 50 patients of pulmonary TB with AFB positive sputum smears attending the OPD of TB and Chest department of B.R.D. Medical College, Gorakhpur were included. Patients were grouped based on history into new (cat-I) and previously treated patients (cat-II). Cat-II patients were further subdivided into defaulter, treatment failure and relapse groups. The culture and DST of AFB positive sputum smears of these patients was done in VersaTREK™®. At the end of study, patients were grouped according to age, sex, category and drug sensitivity pattern for Isoniazid (INH) and Rifampicin (RIF) viz mono resistance (resistance to either INH or RIF) or multi drug resistance (M.D.R.) and the resultant data were analysed.Results: Of the total 50 patients included in this study, 18 (36%) patients were sensitive to both the drugs INH and RIF, of which 11 (22%) were of cat-I and 7 (14%) of category-II. Twenty-two (44%) patients were resistant to INH only of which 8 (16%) were of cat-I and 14 (28%) of cat-II. One (2%) case of cat-I showed resistance to RIF only, while M.D.R. type of resistance is seen in 1 (2%) patient of cat-I and 8 (16%) patients of cat-II. Pattern of resistance to both INH and RIF together (i.e. M.D.R. type) showed significant difference between cat-I and cat-II.Conclusions: Most of the patients showing resistance to INH, RIF or both INH and RIF (M.D.R.) belonged to category-II (previously treated) patients.
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Objectivo: Evaluar la utilidad de Anyplex™II_MTB/MDR/XDR para la detección de Mycobacterium tuberculosis y sensibilidad a medicamentos de primera y segunda línea, además del impacto en la conducta terapéutica en pacientes con sospecha de tuberculosis pulmonar atendidos en una institución de alta complejidad de Medellín, 2014-2015. Material y Metodos: Estudio descriptivo de corte trasversal retrospectivo, de pacientes en cuyo proceso de atención se les realizó: baciloscopia, cultivo Ogawa- Kudoh, prueba molecular Anyplex™II_MTB/MDR/XDR y registro adecuado de historia clínica. Se realizaron medidas estadísticas descriptivas univariadas y de validez diagnóstica. Resultados: Se incluyeron 156 muestras de 154 pacientes, de los cuales el 65,6% fueron hombres. El diagnóstico de ingreso más frecuente fue el Virus de la Inmunodeficiencia Humana (VIH) (46,1%). La sensibilidad y especificidad global fue del 96,36% (IC 95%. 90,51 - 100) y 90,51% (IC 95%: 83,62 - 96,38) respectivamente. Se detectó algún tipo de resistencia en el 12,6%. El 57% de los resultados fueron tomados en cuenta por el médico tratante para definir conductas terapéuticas. Discusión: Se obtuvo una sensibilidad mayor respecto a otros estudios previos. Entre las limitaciones a destacar están: el diseño retrospectivo y la no disponibilidad de medios de cultivo líquido (MIGIT). Conclusión: Anyplex™II_MTB/MDR/XDR fue útil en la identificación del complejo M. tuberculosis y sensibilidad a medicamentos en muestra directa. El resultado de la prueba influyó en la toma de conductas terapéuticas en más de la mitad de los pacientes con resultados positivos. La implementación de nuevas ayudas diagnósticas, deben estar en concordancia con las necesidades en la atención del paciente.
Objective: To evaluate the utility of Anyplex™II_MTB/MDR/XDR for detection of Mycobacterium tuberculosis and drug susceptibility testing to first and second line, and the impact on the therapeutic approach, in patients with suspected pulmonary tuberculosis at a reference hospital. Medellin, 2014-2015. Material and Methods: This is a retrospective, descriptive, observational study in patients that during its hospitalization were studied by: ZN-smear, Ogawa-Kudoh culture, Anyplex™II_MTB/MDR/XDR assay and had an adequate record of medical history. Univariate descriptive statistics was performed and accuracy of the test was analyzed. Results: 156 samples of 154 patients were included, 65.6% were men. The most frequent diagnosis of admission was the Human Immunodeficiency Virus (46.1%). Sensitivity and specificity was 96.36% (95% CI 90.51 to 100) and 90.51% (95% CI 83.62 to 96.38) respectively. Some type of resistance was found in 12.6% of cases. 57% of the results were taken into account to make treatment decisions. Discussions: The sensitivity was higher than regarding in previous studies were obtained, comparing with cultures available at institution. Among limitations, this study was retrospective and the unavailability liquid culture medium (MIGIT). Conclusions: Anyplex™II_MTB/MDR/XDR was useful in the identification of mycobacteria and drug susceptibility in direct sample. The result influenced therapeutic decisions in more than half of patients with positive result. The implementation of new diagnostic aids must be in accordance with the needs in patient care.
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Humans , Male , Adult , Middle Aged , Tuberculosis , Polymerase Chain Reaction , Mycobacterium tuberculosis , Tuberculosis, Pulmonary , Tuberculosis, Pulmonary/therapy , Clinical Laboratory Techniques , Hospital CareABSTRACT
La tuberculosis (TB) es una enfermedad que representa un gran problema de salud pública en países en vías de desarrollo, como lo es el Ecuador, en el que, pese a una incidencia cada vez menor de casos reportados, sigue presente dentro de los grupos vulnerables de la población, como son los pacientes inmunodeprimidos, e incluso existen formas de difícil tratamiento como las multidrogorresistentes (TB-MDR). En este estudio presentamos la frecuencia de casos diagnosticados positivos a través del uso del kit Xpert MTB/RIF (GeneXpert®, Cepheid Innovation) y la frecuencia de casos resistentes a la rifampicina (Rifr). De este estudio, evidenciamos la aplicabilidad y utilidad del ensayo molecular para la detección de TB en muestras pulmonares y extrapulmonares, consiguiendo resultados de positividad del 13 %, y de ellos 7 % Rifr, resultados que superan los obtenidos con técnicas tradicionales de laboratorio.
The tuberculosis (TB),is a major Public Health Issue in the Developing Countries, like Ecuador, in which, in spite of the low incidence of reported infections, TB still exist among the vulnerable population groups, like the immune compromised patients, and also as the multidrug-resistant TB (MDR-TB). In this study, we present the frequency of positive diagnosed cases, using the Xpert MTB/RIF Assay kit (GeneXpert®, Cepheid Innovation) and the frequency of Rifampicin-resistant cases (Rifr). From this study, we evidenced the applicability and utility of this assay in the TB detection in pulmonary and extra-pulmonary samples: 13% were TB positive and 7 % of them were Rifr. These results surpass those obtained through traditional laboratory techniques.
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Humans , Reagent Kits, Diagnostic , Tuberculosis , Tuberculosis, Pulmonary , Risk Groups , Mycobacterium , IncidenceABSTRACT
Abstract Tuberculosis, in particular drug-resistant tuberculosis, is of global concern due to the high mortality and morbidity associated with it annually. The aim of this study was to determine the prevalence of and the risk factors for multidrug-resistant tuberculosis in Iran and its neighboring countries. Four databases (PubMed, BioMed Central, EMBASE, and Web of Science) were searched using key terms. Nineteen eligible articles were identified, of which 12 and seven were used for quantitative and qualitative analysis, respectively. The overall pooled estimate of the prevalence of multidrug-resistant tuberculosis, including both new and previously treated tuberculosis cases, in Iran, Iraq, Turkey and Pakistan was 16% (95% confidence interval [CI] 11-20). The patients with a previous tuberculosis treatment history (odds ratio [OR] = 6.45; 95% CI 5.12-7.79), those aged <45 years (OR = 1.57; 95% CI 1.12-2.03), and those who were males (OR = 1.83; 95% CI 1.19-2.48) had an increased pool risk of developing multidrug-resistant tuberculosis. The forest plot revealed that the pooled odds for the development of multidrug- resistant tuberculosis were 2.01 (95% CI 1.65-2.36). Poor adherence to treatment was one of the predictors of unsuccessful treatment outcomes. Multidrug-resistant tuberculosis is a great concern for public health programs in many countries globally, including those included in this review. The risk factors for the development of multidrug-resistant tuberculosis, specifically a previous tuberculosis treatment history, should be targeted through the implementation of specialized interventions.
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Humans , Tuberculosis, Multidrug-Resistant/epidemiology , Pakistan/epidemiology , Turkey/epidemiology , Prevalence , Risk Factors , Iran , Iraq/epidemiologyABSTRACT
OBJECTIVE:To provide reference for rational use of antituberculosis drugs and reduce the occurrence of ADR in multiple-drug resistance tuberculosis (MDR-TB) patients.METHODS:TB inpatients were selected from our hospital during Feb.2012-May 2015,and then divided into suspected MDR-TB group (202 cases) and diagnosed MDR-TB group (162 cases).According to the patient's condition,different treatment management modes were chosen,and the incidence of ADR were observed.Treatment and management period of 2 groups were 18 months.RESULTS:In suspected MDR-TB group,the drug resistance rates to first line drugs were greater than or equal to 26.24％,among which drug resistance rates to isoniazid and rifampicin were about 40％.Resistance rates to second line-drugs were greater than or equal to 4.95％,among which resistance rate to protionamide was the highest,being 46.04％.The results of drug sensitivity tests showed that 44.06％ of patients were sensitive to all first-line drugs,14.36％ of patients were resistant to single drug,9.90％ of patients were usually resistant to drugs and 31.68％ of patients were resistant to multiple drugs.21.78％ of patients were sensitive to all first-line drugs and second-line drugs,24.75％ of patients were resistant to single drug,17.82％ of patients were usually resistant to drugs,32.67％ of patients were resistant to multiple drugs and 2.97％ of patients were extensively resistant to drugs.In the management plan of MDR-TB patients therapy,56.17％ were treated in tuberculosis control institutions;referral to special hospital for treatment accounted for 14.81％;22.22％ didn't receive any treatment;other factors lead to a change in treatment or unable to continue to treat accounted for 6.79％.The incidence of ADR in MDR-TB patients was higher than suspected MDR-TB patients,there was statistical significance between 2 groups (P＜0.05).After the following symptomatic treatment,all patients were improved.CONCLUSIONS:For patients with MDR-TB,according to disease condition,appropriate treatment management program can be found so as to improve therapeutic efficacy,reduce the incidence of ADR,control spreading and development of tubercle bacillus.
ABSTRACT
Tuberculosis, caused by Mycobacterium tuberculosis, continues to be a serious public health problem around the world, and it urges the need for development of new antitubercular drugs. An antibiotic producing strain, Streptomyces luridus (MTCC 4402) was earlier isolated from soil by our group. In this work, the phylogenic status was established by 16S rRNA gene sequence analysis. The strain was found to be active against clinically resistant strains. The culture was grown in shake flasks in a medium containing cornsteep liquor, glucose, CaCO3, soyabean meal and starch. Antibiotic production reached maximum at the end of 72 h. and fermentation profile was obtained. The active compound was extracted into ethyl acetate and was subjected to activity guided purification by column chromatography using silica gel, TLC and HPLC methods. The pure compound eluted at 16.7 min. by gradient elution was subjected to 1H, 13C NMR and mass spectral analyses. The acquired data was compared with that of natural products’ data base and found to be a known antibiotic, spiramycin. The purified compound was studied for mutagenic, cytotoxicity, antitubercular activities. It was non mutagenic at the concentration of 1000 mg/mL, non cytotoxic and active as antitubercular agent at a concentration of 64 mg/mL and was comparable to rifampicin.
ABSTRACT
Mycobacterium tuberculosis (Mtb) has acquired resistance and consequently the antibiotic therapeutic options available against this microorganism are limited. In this scenario, the use of usnic acid (UA), a natural compound, encapsulated into liposomes is proposed as a new approach in multidrug-resistant tuberculosis (MDR-TB) therapy. Thus the aim of this study was to evaluate the effect of the encapsulation of UA into liposomes, as well as its combination with antituberculous agents such as rifampicin (RIF) and isoniazid (INH) against MDR-TB clinical isolates. The in vitro antimycobacterial activity of UA-loaded liposomes (UA-Lipo) against MDR-TB was assessed by the microdilution method. The in vitro interaction of UA with antituberculous agents was carried out using checkerboard method. Minimal inhibitory concentration values were 31.25 and 0.98 µg/mL for UA and UA-Lipo, respectively. The results exhibited a synergistic interaction between RIF and UA [fractional inhibitory concentration index (FICI) = 0.31] or UA-Lipo (FICI = 0.28). Regarding INH, the combination of UA or UA-Lipo revealed no marked effect (FICI = 1.30-2.50). The UA-Lipo may be used as a dosage form to improve the antimycobacterial activity of RIF, a first-line drug for the treatment of infections caused by Mtb.
Subject(s)
Humans , Antibiotics, Antitubercular/pharmacology , Benzofurans/pharmacology , Isoniazid/pharmacology , Liposomes , Mycobacterium tuberculosis/drug effects , Rifampin/pharmacology , Capsules , Drug Resistance, Multiple, Bacterial/drug effects , Drug Synergism , Microbial Sensitivity TestsABSTRACT
Background & objectives: Pre-extensively drug resistant (pre-XDR) and extensively drug resistant tuberculosis (XDR-TB) have been areas of growing concern, and are posing threat to global efforts of TB control. The present study was planned to study the presence of pre-XDR and XDR Mycobacterium tuberculosis and their genotypes in clinical isolates obtained from previously treated cases of pulmonary TB. Methods: A total of 219 isolates obtained from previously treated cases of pulmonary TB were subjected to first-line (streptomycin, isoniazid, rifampicin and ethambutol) and second-line (ofloxacin, kanamycin, capreomycin and amikacin) drug susceptibility testing on solid Lowenstein-Jensen medium by proportion method. Genotyping was done for pre-XDR and XDR-TB isolates using 12 loci Mycobacterial Interspersed Repetitive Units-Variable Number Tandem Repeats (MIRU-VNTR). Results: Multi-drug resistance was observed in 39.7 per cent (87/219) isolates. Pre-XDR and XDR M. tuberculosis isolates amongst 87 multi-drug resistant (MDR) TB isolates were 43 (49.4%) and 10 (11.4%), respectively. Two most dominant genotypes among pre-XDR and XDR M. tuberculosis isolates were Beijing and Delhi/CAS types. Interpretation & conclusions: Resistance to second-line anti-tubercular drugs should be routinely assessed in areas endemic for TB. Similar genotype patterns were seen in pre-XDR and XDR-TB isolates. Beijing and Delhi/CAS were predominant genotypes.