RESUMEN
Bacground: DST by conventional methods takes several weeks, while early diagnosis of the disease and the rapid identification of resistant strains are essential for efficient treatment and control of the MDR strains. Rapid molecular testing of detecting MDR-TB is needed.Objective: The aim of this study was to assess performance of molecular line probe assay, Genotype16 MTBDRp/us, for rapid detection of RIF and INH resistance for M.Tuberculosis in Mongolia. The sensitivity and specificity of Genotype® MTBDRp/us to detect RIF and INH resistance-associated mutations in culture specimens and directly in smear-positive clinical specimens was examined and compared with conventional culture and drug susceptibility testing on solid medium.Material and Methods: The subjects of this study were 218 MDR-TB suspects aged 14-75 years from 8 districts in Ulaanbaatar city. The study was conducted from July 2009 to May 2010. The Genotype M. Tuberculosis drug resistance first line (MTBDR plus) assay (Hain Life-science, Nehren, Germany) was tested on directly on 41 sputum specimens and 109 clinical isolates.Results: The high correlation of the results from Genotype® MTBDRp/us and conventional drug susceptibility testing was obtained from this study. The results clearly show high performance of Genotype® MTBDRp/us with almost 100% accuracy for all the important indicators, such as sensitivity, specificity, positive and negative predictive values of detection of RIF and INH resistance. Some minor discrepancies were obtained in comparison with DNA sequencing results.Our study found that among high proportion for detection of RIF resistance, S531L mutation (MUT3 band) occurred the most commonly, with 80.0% of all RIF-resistant strains (83.6% of MDR) having the mutation. Other mutation in the 530-533 regions was common, as detected by the lack of binding to the WT8 probe in the absence of S531L mutation.In this study we observed that mutations in the promoter region of inhA gene played a major role (67.6 % (63.9% of MDR strains and 90% of INH-mono-resistant strains) had a mutation in the inhA.Conclusion: The Genotype® MTBDRp/us assay was demonstrated as a rapid, reliable and highly accurate tool for early detection of MDR-TB through examining smear positive cases enabling early start of appropriate therapeutic and public health measures to control of the spread of drug resistant M.tuberculosis in the population.
RESUMEN
From January through July 1994; 58 AIDS patients were enrolled at Mulago Hospital; Makerere Medical School. Of these 58 patients; 30 were assigned to a primary therapy with fluconazole (FLCZ) at a dose of 200mg/day for 2 months and flucytosine (5FC; 150/mg/Kg) for 2 weeks and 28 were assigned to month therapy with FLCZ at the same doze. All the patients who survived for 2 months continued to administrate FLCZ at a doze of 200mg three times per week as a maintenance therapy for 4 months. Fifty patients were evaluated for the survival rate at the end of the therapy for six months. The combination therapy prevented the early death of these patients; while half of patients who received monotherapy died within the first two weeks. The survival rate (32) of 25 patients receiving the combination therapy was significantly higher than that (12) of 25 patients receiving the monotherapy at the end of therapy for 6 months (P0.05). No serious adverse reactions were observed. These data suggest the combination therapy with low dose FLCZ and short course 5FC is cost-effective and safe regimen against CM in AIDS patients in developing countries
RESUMEN
From January through July 1994; 58 AIDS patients were enrolled at Mulago Hospital; Makerere Medical School. Of these 58 patients; 30 were assigned to a primary therapy with fluconazole (FLCZ) at a dose of 200mg/day for 2 months and flucytosine (5FC; 150/mg/Kg) for 2 weeks and 28 were assigned to month therapy with FLCZ at the same doze. All the patients who survived for 2 months continued to administrate FLCZ at a doze of 200mg three times per week as a maintenance therapy for 4 months. Fifty patients were evaluated for the survival rate at the end of the therapy for six months. The combination therapy prevented the early death of these patients; while half of patients who received monotherapy dided within the first two weeks. The survival rate (32) of 25 patients receiving the combination therapy was significantly higher than that (12) of 25 patients receiving the monotherapy at the end of therapy for 6 months (P0.05). No serious adverse reactions were observed. These data suggest the combination therapy with low dose FLCZ and short course 5FC is cost-effective and safe regimen against CM in AIDS patients in developing countries