Detection of multidrug-resistant tuberculosis using MGIT™(TM) and MAS-PCR in Tripura, India.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) poses a global threat that is further compounded by the human immunodeficiency virus (HIV) epidemic. OBJECTIVE: To detect MDR-TB among pulmonary TB (PTB) patients with or without HIV coinfection by isolating and identifying Mycobacterium tuberculosis from clinical samples and performing drug susceptibility testing (DST). METHODS: Sputum was collected from presumed PTB cases. Microscopic examination was performed following Ziehl-Neelsen (ZN) staining and cultured in Löwenstein-Jensen (LJ) medium. First-line anti-tuberculosis DST of the isolates was performed using MGIT™ (Mycobacterial Growth Indicator Tube) and multiplex allele-specific polymerase chain reaction (MAS-PCR). RESULTS: Of 172 study subjects, 59.3% (102/172) were smear-positive and 40.7% (70/172) were smear-negative. In the smear-positive and -negative groups, respectively 62.7% (64/102) and 8.6% (6/70) were culture-positive. DST on MGIT showed a cumulative resistance of 7.1% (5/70) to isoniazid (INH) and rifampicin. More ethambutol (EMB) and combined INH+EMB resistance was detected using MAS-PCR. CONCLUSION: MDR-TB is a problem in Tripura, and culture and phenotypic DST are required for diagnosis. MAS-PCR may provide an alternative rapid screening tool.