A study of clinical profile of cases of MDR-TB and evaluation of challenges faced in initiation of second line Anti tuberculosis treatment for MDR-TB cases admitted in drug resistance tuberculosis center.

OBJECTIVES: To study the clinical profile of cases, evaluation of comorbidities and problems encountered in initiation of second-line drugs for multidrug-resistant tuberculosis (MDR-TB) patients. METHODOLOGY: A prospective observational study was conducted on MDR patients admitted in drug resistance tuberculosis (DRTB) center of RDGMC Surasa Ujjain, a rural medical college, over a span of one year. RESULTS: Out of 130 admitted cases, majority (30%) were between 31 and 40 years of age. Males were predominant (70%). Females were significantly younger compared to males (p=0.00308). Most patients (83.8%) were underweight (body mass index (BMI)<18.5kg/m2). According to MDR-TB suspect criteria, majority were defaulter cases (39.23%). The anemia was the most common comorbidity (73.84%) among the study group followed by diabetes mellitus (9.23%), chronic obstructive pulmonary disease (COPD) (9.23%), 10 (7.69) asthma, 10 (7.69%) thyroid disease 9 (6.92%) followed by respiratory insufficiency 4 (3%), HIV 2 (1.5%), deep venous thrombosis (DVT) 2 (1.5%), renal failure 2 (1.5%), and hepatic failure 1 (0.76%). Majority had minimal lesion - 57 (43.8%), moderate - 38 (29.2%), and moderate advanced - 23 (17.7%) while far advanced was noted on X-rays in 12 (9.2%). A total of 91 (70%) cases had non-cavitary lesions and 39 (30%) had cavitary lesions, of which 27 were unilateral and 12 were bilateral. CONCLUSION: The males were predominant in our study however females were affected at a younger age compared to the males. Most of the patients had taken Anti tuberculosis treatment (ATT) from Revised National Tuberculosis Control Program (RNTCP) in which defaulter and relapse were the major contributors of MDR-TB cases in our study. Radiological extent of lesions of these patients was less than expectation. Management of comorbidities is essential for compliance to treatment. It necessitates prolonged hospitalization and requires frequent follow-up in the DRTB center.

Socio-economical and Clinico-Radiological Profile of 474 MDR TB Cases of a Rural Medical College.

OBJECTIVE: To study the socio economical and clinico radiological profile of 474 diagnosed MDR TB cases who came for the initiation of MDR TB regimen in DRTB center of R.D.Gardi Medical college, Ujjain. METHODOLOGY: This is a retrospective and prospective observational study for a total period of three years from October 2013 to September 2016. The patients were evaluated clinically, radiologically and were investigated thoroughly according to PMDT guidelines and then were started on MDR TB treatment. The study was conducted at drug resistance tuberculosis center (DR-TB) managed by department of Pulmonary Medicine. RESULTS: 474 cases were included in the study and we found that patients were in the age range of 10-84 years, maximum patients were in age group of 30 to 39 years, and mean age was 38 yrs. Male to female ratio was 2.73 to 1, most of the patients in the study were from rural area i.e. 61.6%. Illiteracy was found in 339 (71.5%) cases and out of these 339, 165 patients (48.6%) were defaulter, 101(29.8%) are cases of relapse, 39(11.5%) were failure, 34(10.02%) of new cases. Maximum numbers of patient were in lower class accounting 63.7% and upper lower class 31.6%, lower middle class only 4.5%. Study also showed mean BMI was 14.9 kg/m2 (range 5.7-25.4 kg/m2), 88.6% of patients were undernourished with BMI less then 18.5kg/m2 .The most common symptoms was cough seen in 96%, followed by fever 67.5%, Dyspnea 52.7%, Anorexia 26.2%, chest pain in 19.8% and least common was haemoptysis seen in 7.6% of patient. Common co-morbidities with MDR-TB found was anemia in 176 out of 474 (i.e.37.1%), 123(25.9%) COPD. Radiological severity showed 219(46.2%) moderate lesion, 139 (29.3%) mild, 107(22.6%) extensive lesion and 9(1.9%) normal, 312(65.8%) of patient are non-cavitory and 162 (34.2%) are cavitory in which 99 (20.9%) were unilateral and 63(13.3%) are bilateral cavitory lesion. Defaulter are most common accounting of 218(46.0%), relapse139 (29.3%) and failure 68 (14.3%), new 48 (10.2%), most of them had taken more than one episode of ATT (72.8%). Most common source of ATT taken by patient is RNTCP it accounts 424 (89.5%) and 46 (9.7%) from private. 181 out of 474 (38.2%) cases delayed the treatment for 1-7 days, 82 out of 474 (17.3%) cases delayed treatment for 8-10 days, 96 out of 474 (20.3%) cases delayed treatment for 11-19 days and 115 out of 474 delayed the treatment for more than 19 days. 95 out of 474 cases i.e. 20.1% cases come from more than 150 km away from their residing area for the initiation of treatment. CONCLUSION: The epidemiological picture of TB showed that males were predominant in our study however female were more affected in younger age group compared to male. More than 51% of the cases were in productive age group which affects the socioeconomic condition of family and society. More than 2/3 of patients were from lower socioeconomic group with low BMI. Therefore improving nutrition and immunity can play an important role. 2.3% of the cases were HIV reactive and were on ART. Co-morbidities like COPD and Diabetes were seen in our study which were statistically significant and had impact on the treatment outcome of results. Significant delay in initiation of MDR-TB regimen from date of DST was seen in 24.3% cases which is matter of concern. Most of the patients had taken ATT from RNTCP in which Defaulter and relapse was major contributor of MDR-TB suspect in our study and patient taking ATT privately were less. Large number of cases which resides more than 150 kilometers from DRTB center initiated the drug after a gap of more than 19 days from the date of DST.