To Determine the Frequency of Successful Outcome of Multi-Drug Resistant Tuberculosis Treated as Outpatient in a Tertiary Care Center

Objectives: To determine the frequency of successful outcome of multidrug-resistant tuberculosis treated as outpatient in a tertiary care center. Subject and methods: This was a descriptive cross-sectional study done from 13 April, 2018 to 13 Oct, 2018. All the patients fulfilling inclusion criteria having age 20-60 years of either gender under treatment of MDR-TB for more than six months were enrolled in study the from Programmatic Management of Drug Resistance Tuberculosis (PMDT) site at Department of Pulmonology. Informed consent was taken from patients. Strictly exclusion criteria i.e. patients having neurological or psychological problems before diagnoses of MDR-TB (as per medical record in history), co-infection with HIV, was followed to exclude potential confounder and biases. Education status was evaluated and the response of treatment was checked in matriculate & under matric patients, also socioeconomic status was evaluated by asking about monthly salary whether below or above 12000, and subsequently their effect on treatment outcome. HIV screening is done through ICT method and DST for tuberculosis done on sputum of the patients in the Provincial Reference Lab in Hayat Abad Medical Complex Peshawar for diagnosis. Results: A total of 151 patients were included in this study, among which males were 94, and females were 57. The mean age was 41 years and S.D 10.82. As per the results, 110 (72.84%) patients were having a successful outcome. Conclusion: This study concludes that the out-patient treatment strategy success rate was 72.84% and it is feasible and safe for the treatment of MDR-TB patients.

Prevalence,diagnosis and treatment status of pediatric drug-resistant tuberculosis / 中华实用儿科临床杂志

Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis,which threats the health of children worldwide.Accompany with the increase of drug-resistance tuberculosis,great challenging has arose in the prevention and treatment of tuberculosis.Nowadays,the diagnosis and treatment of drug-resistance tuberculosis is still difficult in pediatric patients.Based on molecular diagnosis,fast detect as well as reliable treatment of drug-re-sistance tuberculosis become available.Currently,the principle of drug-resistant tuberculosis treatment in children is essentially similar to adults.In this review,the mechanism,diagnosis and treatment of pediatric drug resistance tuberculosis were discussed.

Detection of rifampicin resistance in tuberculosis by molecular methods: A report from Eastern Uttar Pradesh, India.

Diagnosis of drug resistance tuberculosis (TB) by the gold standard method is labour intensive and time consuming. Hence, there is an urgent need for introduction of rapid diagnostic techniques. Line probe assay (LPA) and cartridge‑based nucleic acid amplification test (CBNAAT) have been introduced in India under Revised National Tuberculosis Control Program. Spot and morning sputum samples of previously treated patients by anti‑TB drugs were subjected to LPA or CBNAAT. Total 682/1253 (54.4%) were diagnosed as rifampicin‑resistant. The patients could be diagnosed early by molecular methods and put on second line treatment.

Comparison of Efficacy and Safety of Levofloxacin and Moxifloxacin in the Treatment of Patients with Drug-resistant Tuberculosis / 中国药房

OBJECTIVE:To compare the efficacy and safety of levofloxacin and moxifloxacin in the treatment of patients with drug-resistant tuberculosis. METHODS:148 patients with drug-resistant tuberculosis were divided into observation group(74 cases) and control group(74 cases). All patients were treated with 300 mg Aminosalicylic acid isoniazid tablet+250 mg Ethambutol hydro-chloride tablet+200 mg Pyrazinamide tablet+200 mg Protionamide tablet,3 times a day,treatment for 3 months;based on it,obser-vation group was orally given 0.4 g Moxifloxacin hydrochloride tablet,once a day;control group was orally given 0.5 g Levofloxa-cin hydrochloride tablet,once a day. They were treated for 12 months. The total efficacy,sputum negative convevsion rate after 1, 4,8 and 12 months,X-ray cavities lesion improvement and incidence of ADR in 2 groups were observed. RESULTS:The total effi-cacy,sputum negative conversion rate after 1,4,8 and 12 months,and cavity closure and reduced proportion in observation group were significantly higher than control group,the empty change and increase proportion,incidence of ADR were significantly lower control group,the differences were statistically significant (P<0.05). CONCLUSIONS:Based on conventional treatment, moxifloxacin shows better efficacy and safety than levofloxacin in the treatment of patients with drug-resistant tuberculosis.

Role of RNTCP in the management of MDR-TB.

Background: MDR-TB is defined as resistance to isoniazid and rifampicin with or without resistance to other drugs. India is one of the countries with largest burden of MDR TB in the world. Second line Anti-tuberculous therapy is now available for patients with MDR-TB under the RNTCP Category IV. but there are many challenges for MDR-TB control in india. This study was done to analyses the RNTCP data for MDR-TB maintained at a TU, in the city of Ahmedabad, Gujarat, and to compare it with the data available in literature. This study also aimed to identify challenges faced while treating MDR-TB and to address the same. Material and methods: We had restropectively analyzed 353 patients referred to the TU from the respective Direct Microscopy Center (DMC) with suspicion of MDR-TB during a period of January 2014 to December 2014. Results: Of the 353 suspected MDR_TB patients referred to the TU, 48 patients (13.597%) were diagnosed to have MDR-TB. Of these 48 patients, 46 patients had pulmonary TB (95.833%) and 2 patients had extra-pulmonary MDR-TB (4.166%). Of the 48 patients, 08 (16.67%) patients were transferred to their respective TU and 40 patients (83.33%) were enrolled for Cat IV from our TU. Of the 40 patients enrolled at our TU, 30 patients (75%) were continuing Category IV at the end of 2014 (25 were on intensive phase and 05 were on continuation phase), 03 patients (7.5%) died during treatment, 01 patient (2.5%) defaulted treatment, 05 patients (12.5%) refused treatment and 01 patient had XDR-TB (2.5%). Of the 40 patients, 05 patients (12.5%) had ofloxacin resistance. NO patient had intolerance to any oral or injectable ATT. None of the diagnosed MDR-TB patients had HIV co-infection Conclusion: Drug resistance in tuberculosis is a “man-made problem”. Anti-TB chemotherapy must be given optimally by (i) ensuring adequate absorption of drugs, (ii) timely diagnosis and management of drug toxicities and (iii) treatment adherence. To ensure that all patients get adequate treatment and to have a close follow-up of defaulters and patients who refuse treatment; we need to strengthen our existing management information system and also incorporate private sectors into our system.

Drug resistance and short-term efficacy of second-line drugs in patients with multidrug-resistant pulmonary tuberculosis in Zhejiang Province / 中华临床感染病杂志

Objective To investigate drug resistance and clinical efficacy of second-line anti-tuberculosis drugs in patients with multidrug-resistant pulmonary tuberculosis.Methods A total of 183 multi-drug resistant pulmonary tuberculosis (MDR-PTB) patients received standard anti-tuberculosis treatment in Zhejiang Provincial Center for Diagnosis and Treatment of Tuberculosis during March 2011 and March 2013.Patients were divided into four groups according to the results of first-line anti-tuberculosis drugs susceptibility test:group A (n =30) resistant to isoniazid (H) and rifamipicin (R) ; group B (n =28) resistant to HR and ethambutol (E) ; group C (n =53) resistant to HR and streptomycin (S) ; groups D (n =72) resistant to HRES.Drug susceptibility tests of second-line drugs kanamycin (Km),protionamide (Pto),paraaminosalicylic acid (PAS) and levofloxacin (Lfx) were performed.Negative conversion rates of mycobacterium tuberculosis in sputum culture were also observed and compared among different groups with x2 test.Results Among 183 MDR-PTB patients,49 cases (26.8％) were resistant to Lfx,which was significantly higher than that of Km (8.7％,n =16),Pto (13.1％,n =24) and PAS (6.6％,n=12) (x2 =37.983,P＜0.05).The resistant rate to Lfx in group D was 45.8％ (33/72),which was higher than that in group A (2/30,6.7％),group B (6/28,21.4％) and group C (8/53,15.1％) (x2 =14.413,5.047 and 13.087,P ＜0.05).The occurrence of pre-extensively drug resistance (Pre-XDR) in group D was 34.7％ (25/72),which was higher than that in group A (3/30,10.0％) and group C (9/53,17.0％) (x2 =6.499 and 4.852,P ＜ 0.05).Among 157 MDR-PTB patients who received standard anti-tuberculosis treatment for one year,the negative conversion rate of mycobacterium tuberculosis in sputum culture was 87.3％ (137/157).The negative conversion rate in group D was lower than that in other groups,but the difference was not of statistical significance (x2 =1.899,P ＞ 0.05).Conclusions The efficacies of second-line anti-tuberculosis drugs vary among MDR-TB patients resistant to different firstline anti-tuberculosis drugs.The sensitivity tests results of the first-line drugs may serve as reference for MDR chemotherapy regimen in lack of test results of second-line drugs.

Evaluation of GenoType® MTBDRplus assay for rapid detection of drug susceptibility testing of multi-drug resistance tuberculosis in Northern India.

Background: The problem of multi-drug resistance tuberculosis (MDR-TB) is growing in several hotspots throughout the world. Rapid and accurate diagnosis of MDR-TB is crucial to facilitate early treatment and to reduce its spread in the community. The aim of the present study was to evaluate the new, novel GenoType® MTBDRplus assay for rapid detection of drug susceptibility testing (DST) of MDR-TB cases in Northern India. Materials and Methods: A total of 550 specimens were collected from highly suspected drug resistant from pulmonary and extra-pulmonary TB cases. All the specimens were processed by Ziehl- Neelsen staining, culture, differentiation by the GenoType® CM assay, fi rst line DST using BacT/ALERT 3D system and GenoType® MTBDRplus assay. The concordance of the GenoType® MTBDRplus assay was calculated in comparison with conventional DST results. Results: Overall the sensitivity for detection of rifampicin, isoniazid and MDR-TB resistance by GenoType® MTBDRplus assay was 98.0%, 98.4% and 98.2% respectively. Out of 55 MDR-TB strains, 45 (81.8%), 52 (94.5%) and 17 (30.9%) strains showed mutation in rpoB, katG and inhA genes respectively (P < 0.05). The most prominent mutations in rpoB, katG and inhA genes were; 37 (67.3%) in S531L, 52 (94.5%) in S315T1 and 11 (20%) in C15T regions respectively (P < 0.05). Conclusions: Our study demonstrated a high concordance between the GenoType® MTBDRplus assay resistance patterns and those were observed by conventional DST with good sensitivity, specifi city with short turnaround times and to control new cases of MDR-TB in countries with a high prevalence of MDR-TB.

Detection and characterization of mutations of multidrug-resistant tuberculosis isolates of the Philippine General Hospital

BACKGROUND: Emergence of multidrug-resistant tuberculosis (MDR-TB) poses a major challenge to prevailing disease management. MDR-TB arises from mutations in several genes comprising the resistance determining regions, including rpoB, katG and gyrA. OBJECTIVE: To detect and characterize mutations in rpoB, katG and gyrA. METHODS: Thirty selected Mycobacterium tuberculosis isolates from the IDS-PGH were subjected to PCR amplification and sequencing. Sequences were compared to the wild type strain H37Rv. RESULTS: Mutations were detected in codons 512, 513, 516, 522, 526, 531 and 533 of rpoB, codons 280, 281, 315 and 333 of katG, and codons 90 and 94 of gyrA sequences. The most frequently mutating codons for rpoB, katG and gyrA were 531, 315 and 94, respectively. A clustering analysis of the sequences showed occurrence of seven, four and three clusters for the genes rpoB, katG and gyrA, respectively. The eight clusters obtained from the concatenated sequences of the three genes represent the eight potential genotypes of local strains. One cluster represents the wild type strain genotype, another cluster represents the XDR strain genotype, and six clusters represent the MDR strain genotypes. CONCLUSION: These findings indicate the utility of multiple RDR sequence analysis in both identifying specific drug resistance mutation and genotyping of various M. tuberculosis isolates.