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Massud A, Khan AH, Syed Sulaiman SA, Ahmad N, Shafqat M, Ming LC. Unsuccessful treatment outcome and associated risk factors. A prospective study of DR-TB patients from a high burden country, Pakistan. PLoS One 2023; 18:e0287966. [PMID: 37561810 PMCID: PMC10414635 DOI: 10.1371/journal.pone.0287966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 06/19/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Tuberculosis (TB), a curable and preventable infectious disease, becomes difficult to treat if resistance against most effective and tolerable first line anti-TB drugs is developed. The objective of the present study was to evaluate the treatment outcomes and predictors of poor outcomes among drug-resistant tuberculosis (DR-TB) patients treated at a programmatic management unit of drug resistant tuberculosis (PMDT) unit, Punjab, Pakistan. METHODS This prospective observational study was conducted at a a PMDT unit in Multan, Punjab, Pakistan. A total of 271 eligible culture positive DR-TB patients enrolled for treatment at the study site between January 2016 and May 2017 were followed till their treatment outcomes were recorded. World Health Organization's (WHO) defined criteria was used for categorizing treatment outcomes. The outcomes of cured and treatment completed were collectively placed as successful outcomes, while death, lost to follow-up (LTFU) and treatment failure were grouped as unsuccessful outcomes. Multivariable binary logistic regression analysis was employed for getting predictors of unsuccessful treatment outcomes. A p-value <0.05 was considered statistically significant. RESULTS Of the 271 DR-TB patients analysed, nearly half (51.3%) were males. The patient's (Mean ± SD) age was 36.75 ± 15.69 years. A total of 69% patients achieved successful outcomes with 185 (68.2%) patients being cured and 2 (0.7%) completed therapy. Of the remaining 84 patients with unsuccessful outcomes, 48 (17.7%) died, 2 (0.7%) were declared treatment failure, 34 (12.5%) were loss to follow up. After adjusting for confounders, patients' age > 50 years (OR 2.149 (1.005-4.592) with p-value 0.048 and baseline lung cavitation (OR 7.798 (3.82-15.919) with p-value <0.001 were significantly associated with unsuccessful treatment outcomes. CONCLUSIONS The treatment success rate (69%) in the current study participants was below the target set by WHO (>75%). Paying special attention and timely intervention in patients with high risk of unsuccessful treatment outcomes may help in improving treatment outcomes at the study site.
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Affiliation(s)
- Asif Massud
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Nafees Ahmad
- Faculty of Pharmacy, University of Balochistan, Quetta, Pakistan
| | - Muhammad Shafqat
- Programmatic Management of Drug-Resistant Tuberculosis (PMDT) Unit, Nishtar Medical University Hospital, Multan, Pakistan
| | - Long Chiau Ming
- School of Medical and Life Sciences, Sunway University, Sunway City, Selangor Darul Ehsan, Malaysia
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Hymn PK, Gurjar Y, Savani NM. A Retrospective Analysis of Clinico-Demographic and Genetic Characteristics and Treatment Outcomes in Isoniazid Mono-Resistant Tuberculosis Patients: A Single-Center Study. Cureus 2023; 15:e42166. [PMID: 37602046 PMCID: PMC10439306 DOI: 10.7759/cureus.42166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
INTRODUCTION Treatment failure and relapse rates are more likely to occur when there is isoniazid (INH) resistance. So, we can no longer ignore the problem of isoniazid mono-resistance. It is pertinent to control the spread of primary INH resistance and prevent secondary resistance. AIM This study aims to evaluate subjects' clinical, demographic, and genetic characteristics and explore their treatment outcomes. METHODS All data of isoniazid mono-resistant tuberculosis (TB) patients, which were maintained in the electronic database of mandatory notifications (NIKSHAY Portal) between 2017 and 2022, were reviewed. A total of 54 patients were included after excluding five patients with ongoing treatment. RESULTS Of 54 patients, 41 (75.9%) were cured, which was classified under favorable outcome, and the rest were classified under unfavorable outcome. Phenotypic, high-level mutation (katG) was found in 48 (88.9%) patients. Kaplan-Meier curves show that survival probabilities increase in weeks with regular intake of drugs. CONCLUSION Our study found that those with younger ages and males were more affected. We found favorable outcomes in the majority of patients.
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Affiliation(s)
- Parikh K Hymn
- Pulmonary Medicine, Shantabaa Medical College and General Hospital, Amreli, IND
| | - Yamini Gurjar
- Community Medicine, Shantabaa Medical College, Amreli, IND
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Muacevic A, Adler JR, Farooq F. Role of Multi-Detector Computed Tomography in the Diagnosis of Intestinal Obstruction. Cureus 2023; 15:e33730. [PMID: 36788830 PMCID: PMC9922381 DOI: 10.7759/cureus.33730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION There is a need to identify patients whose small bowel obstruction (SBO) can resolve spontaneously so that unnecessary surgical interventions are avoided. This study aimed to evaluate the diagnostic accuracy of multi-detector computed tomography (MDCT) in intestinal obstruction and find out the presence, level, causes, and degree of intestinal obstruction taking intraoperative findings as gold standard. METHODOLOGY This cross-sectional study was conducted analyzing 147 patients that were referred from emergency with abdominal pain, abdominal distension, inability to pass flatus, and aged 18-70 years from both genders. Computed tomography (CT) examinations were done and findings like intestinal dilatation, evidence of mesenteric fat stranding, and area of transition between the dilated and collapsed loops were noted. The final report was made by the radiologist while the operative findings were reviewed from the operative notes written by operative surgeons of the same patient. RESULTS In a total of 147 patients, mean age was 52.38±16.01 years. There were 76 (51.70%) males and 71 (48.30%) females. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of multi-detector computed tomography scan in diagnosing intestinal obstruction, taking operative findings as gold standard, were 98.39%, 65.22%, 93.85%, 88.24%, and 93.20%, respectively. CONCLUSION The multi-detector CT can be used routinely as a prime modality for detecting intestinal obstruction which will result in proper and timely management for reducing the morbidity and mortality of these particular patients.
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Predictors of unfavourable treatment outcome in patients diagnosed with drug-resistant tuberculosis in the Torres Strait / Papua New Guinea border region. PLoS One 2022; 17:e0266436. [PMID: 36490236 PMCID: PMC9733860 DOI: 10.1371/journal.pone.0266436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
Drug-resistant tuberculosis (DR-TB) is an ongoing challenge in the Torres Strait Islands (TSI) / Papua New Guinea (PNG) border region. Treatment success rates have historically been poor for patients diagnosed with DR-TB, leading to increased transmission. This study aimed to identify variables associated with unfavourable outcome in patients diagnosed with DR-TB to inform programmatic improvements. A retrospective study of all DR-TB cases who presented to Australian health facilities in the Torres Strait between 1 March 2000 and 31 March 2020 was performed. This time period covers four distinct TB programmatic approaches which reflect Australian and Queensland Government decisions on TB management in this remote region. Univariate and multivariate predictors of unfavourable outcome were analysed. Unfavourable outcome was defined as lost to follow up, treatment failure and death. Successful outcome was defined as cure and treatment completion. In total, 133 patients with resistance to at least one TB drug were identified. The vast majority (123/133; 92%) of DR-TB patients had pulmonary involvement; and of these, 41% (50/123) had both pulmonary and extrapulmonary TB. Unfavourable outcomes were observed in 29% (39/133) of patients. Patients living with human immunodeficiency virus, renal disease or diabetes (4/133; 4/133; 3/133) had an increased frequency of unfavourable outcome (p <0.05), but the numbers were small. Among all 133 DR-TB patients, 41% had a low lymphocyte count, which was significantly associated with unfavourable outcome (p <0.05). We noted a 50% increase in successful outcomes achieved in the 2016-2020 programmatic period, compared to earlier periods (OR 5.3, 95% Confidence Interval [1.3, 20.4]). Being a close contact of a known TB case was associated with improved outcome. While DR-TB treatment outcomes have improved over time, enhanced surveillance for DR-TB, better cross border collaboration and consistent diagnosis and management of comorbidities and other risk factors should further improve patient care and outcomes.
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Kim SH, Shin YM, Yoo JY, Cho JY, Kang H, Lee H, Choe KH, Lee KM, Yang B. Clinical Factors Associated with Cavitary Tuberculosis and Its Treatment Outcomes. J Pers Med 2021; 11:jpm11111081. [PMID: 34834433 PMCID: PMC8622689 DOI: 10.3390/jpm11111081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/17/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
Cavitary pulmonary tuberculosis (TB) is associated with poor outcomes, treatment recurrence, higher transmission rates, and the development of drug resistance. However, reports on its clinical characteristics, associated factors, and treatment outcomes are lacking. Hence, this study sought to evaluate the clinical factors associated with cavitary pulmonary TB and its treatment outcomes. We retrospectively evaluated 410 patients with drug-susceptible pulmonary TB in a university hospital in Korea between 2014 and 2019. To evaluate the factors associated with cavitary TB, multivariable logistic regression was performed with adjustments for potential confounders. We also compared the treatment outcomes between patients with cavitary TB and those without cavitary TB. Of the 410 patients, 244 (59.5%) had non-cavitary TB and 166 (40.5%) had cavitary TB. Multivariable logistic analysis with forward selection method showed that body mass index (BMI) (adjusted OR = 0.88, 95% CI: 0.81–0.97), previous history of TB (adjusted OR = 3.45, 95% CI: 1.24–9.59), ex- or current smoker (adjusted OR = 1.77, 95% CI: 1.01–3.13), diabetes mellitus (adjusted OR = 2.72, 95% CI: 1.36–5.44), and positive results on the initial sputum acid-fast bacilli (AFB) smear (adjusted OR = 2.24, 95% CI: 1.26–3.98) were significantly associated with cavitary TB. Although treatment duration was significantly longer in patients with cavitary TB than in those with non-cavitary TB (248 (102–370 days) vs. 202 (98–336 days), p < 0.001), the recurrence rate after successful treatment was significantly higher in the patients with cavitary TB than in those with non-cavitary TB (0.4% vs. 3.0% p = 0.042). In conclusion, ex- or current smoker, lower BMI, previous history of TB, diabetes mellitus, and positivity of the initial AFB smear were associated with cavitary TB. The patients with cavitary TB had more AFB culture-positive results at 2 months, longer treatment duration, and higher recurrence rates than those with non-cavitary TB.
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Affiliation(s)
- Sun-Hyung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, Korea; (S.-H.K.); (Y.M.S.); (J.Y.C.); (H.K.); (K.H.C.); (K.M.L.)
| | - Yoon Mi Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, Korea; (S.-H.K.); (Y.M.S.); (J.Y.C.); (H.K.); (K.H.C.); (K.M.L.)
| | - Jin Young Yoo
- Department of Radiology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, Korea;
| | - Jun Yeun Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, Korea; (S.-H.K.); (Y.M.S.); (J.Y.C.); (H.K.); (K.H.C.); (K.M.L.)
| | - Hyeran Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, Korea; (S.-H.K.); (Y.M.S.); (J.Y.C.); (H.K.); (K.H.C.); (K.M.L.)
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Korea;
| | - Kang Hyeon Choe
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, Korea; (S.-H.K.); (Y.M.S.); (J.Y.C.); (H.K.); (K.H.C.); (K.M.L.)
| | - Ki Man Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, Korea; (S.-H.K.); (Y.M.S.); (J.Y.C.); (H.K.); (K.H.C.); (K.M.L.)
| | - Bumhee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, Korea; (S.-H.K.); (Y.M.S.); (J.Y.C.); (H.K.); (K.H.C.); (K.M.L.)
- Correspondence:
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Abbas S, Denholm J, Kermode M, Xiaoguang Y, Kane S. Receiving healthcare for drug-resistant TB: a cross-sectional survey from Pakistan. Public Health Action 2021; 11:114-119. [PMID: 34567986 DOI: 10.5588/pha.20.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe and quantify patients' self-reported experiences of receiving healthcare from Pakistan's Programmatic Management of Drug-Resistant Tuberculosis (PMDT) model of care, and to understand these experiences within the broader context of Pakistan's health system. METHOD This was a cross-sectional survey of patients attending three PMDT clinics in Khyber-Pakhtunkhwa Province in Pakistan. RESULTS The median consultation time at the PMDT clinics was 10 minutes. In their most recent visit to the PMDT clinic, 34.9% of patients spent >40% of their monthly income to access treatment. To specify, 71% of patients reported spending out-of-pocket for ancillary medicines and 44.7% for laboratory tests. In 10.5% of cases, medicines for drug-resistant TB (DR-TB) were dispensed without the patient attending the clinic. Only 43.7% of treatment supporters regularly accompanied patients to the clinic, and 6% supervised the patient's intake of medicines. Disbursement of financial support was irregular in 98.6% of cases. Only 6.2% of patients received their daily injections from a public facility, the rest went elsewhere. CONCLUSION Several shortcomings in PMDT services, including hurried consultations, irregularities in financial support, and gaps in Pakistan's broader health system undermined healthcare experience of patients with DR-TB. To improve health outcomes and patients' care experience these service gaps need to be addressed.
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Affiliation(s)
- S Abbas
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - J Denholm
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC, Australia
| | - M Kermode
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Y Xiaoguang
- School of Public Health, Fudan University, Shanghai, China
| | - S Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Kandi S, K TK, Kandi SR, Mathur N, D CD, Adepu R. Study of treatment outcomes of multidrug-resistant tuberculosis under programmatic conditions and factors influencing the outcomes in Hyderabad District. Indian J Tuberc 2021; 68:379-383. [PMID: 34099204 DOI: 10.1016/j.ijtb.2020.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/15/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Treatment outcomes for Multidrug-Resistant Tuberculosis (MDR TB) is generally poor. The study aims to know about the treatment outcomes of MDR-TB under programmatic conditions in Hyderabad District and to analyze the factors influencing the treatment outcomes. METHODS This is a retrospective study in which 377 patients of Hyderabad district, Telangana state who were diagnosed with MDR TB and registered at Drug Resistance TB Treatment site of Government General & Chest Hospital, Hyderabad from 4th quarter 2008 to 4th quarter 2013 were included in the study. Impact of Demographic factors (age, sex; Nutritional status (BMI); Co-morbid condition (Diabetes, HIV, Hypothyroidism); Programmatic factors (time delay in the initiation of treatment); Initial Resistance pattern on the outcomes were studied and analyzed. RESULTS The treatment outcomes of Multidrug-Resistant Tuberculosis under Programmatic Conditions were: 57% cured, 21.8% died, 19.6% defaulted, 1.1% failed and 0.5% switched to XDR. Age, Sex, BMI had a statistically significant impact on treatment outcomes. Hypothyroidism and Delay in the initiation of treatment >1 a month had an impact on the outcomes though not statistically significant. NO impact on treatment outcomes was found when Rifampicin resistance & INH sensitive patients were compared with those resistant to both INH and Rifampicin. CONCLUSION To reduce MDR-TB transmission in the community, improvement of treatment outcomes, via ensuring adherence, paying special attention to elderly patients is required. The Programmatic Management of Drug Resistance Tuberculosis (PMDT) should seriously think of providing Nutritional support to patients with low BMI to improve outcomes. In the programmatic conditions if we could address the problems like delay in initiation of treatment and proper management of comorbidities like HIV, Diabetes, Hypothyroidism would definitely improve the treatment outcomes.
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Affiliation(s)
- Subhakar Kandi
- Department of Respiratory Medicine, Kamineni Academy of Medical Sciences & Research Centre, Hyderabad, Telangana, India
| | - Tilak Kumar K
- Department of Respiratory Medicine, Government General & Chest Hospital, Osmania Medical College, Hyderabad, Telangana, India.
| | | | - Neeta Mathur
- Department of Community Medicine, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India
| | - Challa Devi D
- District TB Control Officer, Hyderabad, Telangana, India
| | - Rajesham Adepu
- Joint Director of Tuberculosis, Hyderabad, Telangana, India
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Atif M, Ahmad W, Ahmad N, Malik I, Sarwar S. Treatment outcomes among multidrug-resistant TB patients in Bahawal Victoria Hospital, Bahawalpur, Pakistan: a retrospective record review. Trans R Soc Trop Med Hyg 2021; 114:733-741. [PMID: 32556195 DOI: 10.1093/trstmh/traa040] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/28/2020] [Accepted: 05/12/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study aims to evaluate the treatment outcomes and factors associated with unsuccessful treatment outcomes among multidrug-resistant TB (MDR-TB) patients. METHOD This was a retrospective observational study conducted at the Bahawal Victoria Hospital, Bahawalpur, Pakistan. The sociodemographic, clinical and treatment-related data of MDR-TB patients registered at the study site between June 2014 and December 2016 were retrospectively collected. Patients' treatment outcomes were categorized on the basis of WHO-recommended criteria. Multivariate binary logistic regression analysis was used to find the independent factors associated with unsuccessful treatment outcomes. RESULTS Out of 179 MDR-TB patients, 106 (59.2%) completed their treatment successfully. The remaining 73 patients (40.8%) had unsuccessful treatment outcomes, among whom 45 (25.1%) died, while 18 (10.1%) were lost to follow-up. Factors associated with unsuccessful treatment outcomes included age ≥40 y (AOR 4.310; p = 0.006), unsuccessful interim treatment outcomes (AOR 5.810; p = 0.032), occurrence of adverse events (AOR 0.290; p = 0.029) and ofloxacin resistance (AOR 2.952; p = 0.042). CONCLUSION The treatment success rate among the selected cohort of MDR-TB patients was less than the target of ≥75% set by the WHO in the End TB Strategy. The lower treatment success rate at the study site requires urgent attention from clinicians and program managers.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| | - Wajiha Ahmad
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| | - Nafees Ahmad
- Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Balochistan, Pakistan
| | - Iram Malik
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| | - Sajjad Sarwar
- Department of Pulmonology, Bahawal Victoria Hospital, Bahawalpur, Punjab, Pakistan
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Charan AS, Gupta N, Dixit R, Arora P, Patni T, Antony K, Singh M. Pattern of InhA and KatG mutations in isoniazid monoresistant Mycobacterium tuberculosis isolates. Lung India 2020; 37:227-231. [PMID: 32367844 PMCID: PMC7353940 DOI: 10.4103/lungindia.lungindia_204_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aims and Objectives: The aim of the study is to detect the pattern of genetic mutation, i.e., InhA or KatG or both (InhA and katG) in isoniazid (INH) monoresistant mycobacteria and to correlate with the pattern in multidrug-resistant (MDR) isolates. Materials and Methods: In this study, a quantitative research approach was used. The research design was descriptive observational study. The study was conducted at the Department of Respiratory Medicine, JLN Medical College, Ajmer, Rajasthan, and Intermediate Referral Laboratory, State TB Demonstration Centre, Ajmer. A total of 298 samples found to have resistant strains of Mycobacterium tuberculosis were enrolled with purposive sampling. Results: The mean age of patients was 40.27 ± 13.82 years. There were 250 (83.9%) males, while 48 (16.1%) were females. One hundred ninety-two (64.4%) were resistant for INH only, while the rest were resistant to both INH as well as rifampicin (MDR-tuberculosis). The most common mutation in INH monoresistance was katG (125; 65.1%) as compared to inhA (54; 28.1%) and both inhA and katG (13; 6.7%). Among katG mutations, the most common gene pattern was the absence of WT (S315T) and the presence of MUT1 (S315T1). Conclusion: Knowledge about mutation patterns of different INH resistant strains is important in the present era where there is a provision of separate regimens for INH monoresistant TB. Since these mutations are very closely related to high- or low-degree resistance to INH, the therapeutic regimens cannot be generalized.
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Affiliation(s)
- Ashok Singh Charan
- Department of Respiratory Medicine, JLN Medical College, Ajmer, Rajasthan, India
| | - Neeraj Gupta
- Department of Respiratory Medicine, JLN Medical College, Ajmer, Rajasthan, India
| | - Ramakant Dixit
- Department of Respiratory Medicine, JLN Medical College, Ajmer, Rajasthan, India
| | - Piyush Arora
- Department of Respiratory Medicine, JLN Medical College, Ajmer, Rajasthan, India
| | - Tarun Patni
- State TB Demonstration Centre, Ajmer, Rajasthan, India
| | - Kalliath Antony
- Department of Respiratory Medicine, JLN Medical College, Ajmer, Rajasthan, India
| | - Manisha Singh
- Department of Psychiatry, JLN Medical College, Ajmer, Rajasthan, India
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Chaves Torres NM, Quijano Rodríguez JJ, Porras Andrade PS, Arriaga MB, Netto EM. Factors predictive of the success of tuberculosis treatment: A systematic review with meta-analysis. PLoS One 2019; 14:e0226507. [PMID: 31881023 PMCID: PMC6934297 DOI: 10.1371/journal.pone.0226507] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/27/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To produce pooled estimates of the global results of tuberculosis (TB) treatment and analyze the predictive factors of successful TB treatment. METHODS Studies published between 2014 and 2019 that reported the results of the treatment of pulmonary TB and the factors that influenced these results. The quality of the studies was evaluated according to the Newcastle-Ottawa quality assessment scale. A random effects model was used to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) in February 2019 under number CRD42019121512. RESULTS A total of 151 studies met the criteria for inclusion in this review. The success rate for the treatment of drug-sensitive TB in adults was 80.1% (95% CI: 78.4-81.7). America had the lowest treatment success rate, 75.9% (95% CI: 73.8-77.9), and Oceania had the highest, 83.9% (95% CI: 75.2-91.0). In children, the success rate was 84.8% (95% CI: 77.7-90.7); in patients coinfected with HIV, it was 71.0% (95% CI: 63.7-77.8), in patients with multidrug-resistant TB, it was 58.4% (95% CI: 51.4-64.6), in patients with and extensively drug-resistant TB it was 27.1% (12.7-44.5). Patients with negative sputum smears two months after treatment were almost three times more likely to be successfully treated (OR 2.7; 1.5-4.8), whereas patients younger than 65 years (OR 2.0; 1.7-2.4), nondrinkers (OR 2.0; 1.6-2.4) and HIV-negative patients (OR 1.9; 1.6-2.5 3) were two times more likely to be successfully treated. CONCLUSION The success of TB treatment at the global level was good, but was still below the defined threshold of 85%. Factors such as age, sex, alcohol consumption, smoking, lack of sputum conversion at two months of treatment and HIV affected the success of TB treatment.
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Affiliation(s)
- Ninfa Marlen Chaves Torres
- Department of Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Medicine, Nueva Granada Military University, Bogotá, D.C., Colombia
| | | | | | - María Belen Arriaga
- Gonzalo Moniz Institute, Gonzalo Cruz Foundation, Salvador, Bahia, Brazil
- Department of Epidemiology, José Silveira Foundation, Salvador, Bahia, Brazil
| | - Eduardo Martins Netto
- Department of Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Epidemiology, José Silveira Foundation, Salvador, Bahia, Brazil
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Karuniawati H, Putra ON, Wikantyasning ER. Impact of pharmacist counseling and leaflet on the adherence of pulmonary tuberculosis patients in lungs hospital in Indonesia. Indian J Tuberc 2019; 66:364-369. [PMID: 31439181 DOI: 10.1016/j.ijtb.2019.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/28/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND One of the goals of counseling in patients with chronic diseases including tuberculosis patients is to improve adherence to taking medication. By patient adherence, therapeutic results are more optimal. Additional counseling alternatives such as leaflets may be needed to make easier for patients to obtain information about their treatment. This study aimed to analyze the effectiveness of counseling with and without leaflets on the adherence on taking tuberculosis (TB) drugs. METHODS This study was a quantitative research conducted using a quasi-experiment method with a control group for pre-test and post-test design. Data was taken by consecutive sampling. The number of samples in this study was 75 respondents which divided into three groups: counseling, counseling with leaflets, and control that is a usual care in hospital. The inclusion criteria were patients diagnosed with pulmonary tuberculosis with age 25-55 years, who has been taking TB medicines for at least one month and can communicate well. Data was analyzed using Wilcoxon and Kruskal-Wallis with post hoc Mann-Whitney due to abnormality of the distributed data. RESULTS Before the intervention, of 20 respondents (42.6%) out of 75 respondents were obedient to their TB medicines, whereas after the intervention the number of obedient patients was 33 respondents (70.2%). There was a significant increase in adherence between before and after two weeks of counseling intervention with a p-value of 0.029 before and after two weeks of counseling with leaflets with a p-value of 0.003. Counseling and counseling with leaflets improved patients' adherence compare to control group with p-values of 0.028 and 0.001 respectively. CONCLUSION Counseling and counseling with leaflet impact in patients' adherence to tuberculosis medication.
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Affiliation(s)
- Hidayah Karuniawati
- Faculty of Pharmacy, Universitas Muhammadiyah Surakarta, Jl. A. Yani Tromol Pos 1, Pabelan, Kartasura, Surakarta, 57102, Indonesia.
| | - Okta Nama Putra
- Faculty of Pharmacy, Universitas Muhammadiyah Surakarta, Jl. A. Yani Tromol Pos 1, Pabelan, Kartasura, Surakarta, 57102, Indonesia
| | - Erindyah Retno Wikantyasning
- Faculty of Pharmacy, Universitas Muhammadiyah Surakarta, Jl. A. Yani Tromol Pos 1, Pabelan, Kartasura, Surakarta, 57102, Indonesia
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12
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Hameed S, Ahmad SR, Rahman MAU, Nazir H, Ullah I. Drug resistance profile of Mycobacterium tuberculosis and predictors associated with the development of drug resistance. J Glob Antimicrob Resist 2019; 18:155-159. [PMID: 30910744 DOI: 10.1016/j.jgar.2019.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/07/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES Drug-resistant tuberculosis (DR-TB) is a major challenge to national TB control programmes in developing countries. In the Pakistan province of Punjab, the extent and development of DR-TB is not well known. The current study was therefore conducted to assess the incidence and predictors of DR-TB in Punjab Province. METHODS Drug susceptibility testing was performed for 863 confirmed culture-positive Mycobacterium tuberculosis isolates using the proportion method. Patients were enrolled in the Programmatic Management of Drug-Resistant TB Unit of Gulab Devi Chest Hospital (Lahore, Pakistan) from August 2011 to September 2013. Data analysis was performed using IBS SPSS Statistics v.20. Multivariate logistic regression analysis was performed to assess risk factors for DR-TB. RESULTS The rate of resistance to at least one drug (i.e. DR-TB) was 35.0% (302/863) and the rate of multidrug-resistant TB (MDR-TB) was 30.0% (259/863). Among DR-TB cases, the number of females was relatively higher (167/302; 55.3%) compared with males. The majority of DR-TB patients resided in a rural area (229/302; 75.8%). Significant predictors of DR-TB were age 18-45 years, previous TB treatment, rural residence, being a housewife, being married, duration of sickness >1year and unemployment. CONCLUSION The problem of DR-TB in Pakistan is significant. The strongest risk factors were young age and previous anti-TB treatment. Being married, being a housewife, rural residence and unemployment were also risk factors, culminating in an urgent need for effective control, early diagnosis and treatment policies for DR-TB.
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Affiliation(s)
- Salma Hameed
- College of Earth and Environmental Sciences, University of the Punjab, Quaid-i-Azam Campus, Lahore, Pakistan.
| | - Sajid Rashid Ahmad
- College of Earth and Environmental Sciences, University of the Punjab, Quaid-i-Azam Campus, Lahore, Pakistan
| | | | - Humera Nazir
- Institute of Pure and Applied Biology, Bahauddin Zakariya University, Multan, Pakistan
| | - Irfan Ullah
- Gomal Centre of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan; Programmatic Management of Drug-Resistant TB Unit, TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan.
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13
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Atif M, Bashir A, Ahmad N, Fatima RK, Saba S, Scahill S. Predictors of unsuccessful interim treatment outcomes of multidrug resistant tuberculosis patients. BMC Infect Dis 2017; 17:655. [PMID: 28962599 PMCID: PMC5622487 DOI: 10.1186/s12879-017-2746-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 09/19/2017] [Indexed: 11/16/2022] Open
Abstract
Background Interim treatment outcomes at 6-months for multidrug-resistant tuberculosis (MDR-TB) treatment are among the most basic performance monitoring and key evaluation indicators in the Stop and End TB strategy of the World Health Organization (WHO). Therefore, this study was conducted to evaluate the interim treatment outcomes of MDR-TB patients in Pakistan. Methods This study was conducted at the Programmatic Management Unit for Drug-resistance TB (PMDT) site of the National Tuberculosis Program (NTP), Pakistan. It is located in the Chest Disease Unit (CDU) of the Bahawal Victoria Hospital (BVH), Bahawalpur, Punjab, Pakistan. Data was collected between April 1, 2014 and December 31, 2015. The medical records, Electronic Nominal Recording Reporting System (ENRS) data and MRD-TB notification forms of the MDR-TB patients registered at the PMDT site were reviewed to obtain data. For reporting and calculation of interim treatment outcomes, standardized WHO methodology was adopted. Simple logistic regression analysis was used to examine the possible association between the dependent variable (i.e. unsuccessful interim treatment outcome) and selected socio-demographic and clinical variables. Results A total of 100 drug-resistant TB (DR-TB) patients (all types) were registered during the study period. Out of these, 80 were MDR-TB patients for whom interim results were available. Out of the 80 MDR-TB cases, 48 (60%) were classified under the successful interim treatment outcome category. The remaining 40% had unsuccessful 6-month treatment outcomes and 12 (15%) patients died, while nine (11.3%) were lost to follow-up by six months. The final predictors of unsuccessful interim treatment outcomes were; being resistant to ofloxacin (AOR 3.23, 95% CI 0.96–10.89; p-value = 0.04), having above normal baseline serum creatinine levels (AOR 6.49, 95% CI 1.39–30.27; p-value = 0.02), and being culture positive at the second month of treatment (AOR 6.94, 95% CI 2–24.12; p-value = 0.01). Conclusions Despite free treatment and programmatic efforts to ensure patient adherence, the high rate of unsuccessful interim treatment outcomes is concerning. The identified risk factors for unsuccessful interim treatment outcomes in the current study provides clinicians an opportunity to identify high-risk patients and ensure enhanced clinical management and greater treatment success rates. Electronic supplementary material The online version of this article (10.1186/s12879-017-2746-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan.
| | - Arslan Bashir
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Nafees Ahmad
- Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Razia Kaneez Fatima
- Research Unit, National Tuberculosis Control Program of Pakistan, Islamabad, Pakistan
| | - Sehar Saba
- Chest Disease Unit, Bahawal Victoria Hospital, Bahawalpur, Pakistan
| | - Shane Scahill
- School of Management, Massey University, Auckland, New Zealand
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14
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Smear Positive Pulmonary Tuberculosis (TB) Patients Suspected to Have Drug Resistant TB in Programmatic Management of Drug Resistant TB Unit in Khyber Pakhtunkhwa, Pakistan. Jundishapur J Microbiol 2017. [DOI: 10.5812/jjm.14492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Alene KA, Yi H, Viney K, McBryde ES, Yang K, Bai L, Gray DJ, Clements ACA, Xu Z. Treatment outcomes of patients with multidrug-resistant and extensively drug resistant tuberculosis in Hunan Province, China. BMC Infect Dis 2017; 17:573. [PMID: 28814276 PMCID: PMC5559784 DOI: 10.1186/s12879-017-2662-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/01/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The worldwide emergence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) has posed additional challenges for global tuberculosis (TB) control efforts, as limited treatment options are available and treatment outcomes are often sub-optimal. This study determined treatment outcomes among a cohort of MDR-TB and XDR-TB patients in Hunan Province, China, and identified factors associated with poor treatment outcomes. METHODS We conducted a retrospective study using data obtained from medical records of TB patients in Hunan Chest Hospital, and from the internet-based TB management information system managed by the Tuberculosis Control Institute of Hunan Province, for the period 2011 to 2014. Treatment outcomes were assessed for patients diagnosed with MDR-TB (TB resistant to at least isoniazid and rifampicin) and XDR-TB (MDR-TB plus resistance to any fluoroquinolone and at least 1 second-line injectable drug). Cumulative incidence functions were used to estimate time to events (i.e. poor treatment outcomes, loss to follow-up, and unfavourable treatment outcomes); and a competing-risks survival regression model was used to identify predictors of treatment outcomes. RESULT Of 481 bacteriologically-confirmed patients, with a mean age of 40 years (standard deviation SD ± 13 years), 10 (2%) had XDR-TB and the remainder (471; 98%) had MDR-TB. For the entire cohort, treatment success was 57% (n = 275); 58% (n = 272) for MDR-TB and 30% (n = 3) for XDR-TB. Overall, 27% were lost to follow-up (n = 130), 27% (n = 126) for MDR-TB and 40% (n = 4) for XDR-TB; and 16% had a poor treatment outcome (n = 76), 15% for MDR-TB and 30% (n = 3) for XDR-TB. Of the 10 XDR-TB patients, 3 (30%) completed treatment, 3 (30%) died and 4 (40%) were lost to follow-up. Of the 471 MDR-TB patients, 258 (57%) were cured, 16 (3%) completed treatment, 13 (3%) died, 60 (13%) experienced treatment failure, and 126 (27%) were lost to follow-up. Resistance to ofloxacin was an independent predictor of poor (AHR = 3.1; 95%CI = 1.5, 6.3), and unfavourable (AHR = 1.7; 95%CI = 1.07, 2.9) treatment outcomes. Patients who started treatment during 2011-2012 (AHR = 2.8; 95% CI = 1.5, 5.3) and 2013 (AHR = 2.1; 95% CI = 1.2, 3.9) had poorer treatment outcomes compared to patients who started treatment during 2014. CONCLUSION Patients with MDR-TB and XDR-TB had low rates of treatment success in Hunan Province, especially among patients who started treatment during 2011 to 2013, with evidence of improved treatment outcomes in 2014. Resistance to ofloxacin was an independent predictor of poor treatment outcomes.
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Affiliation(s)
- Kefyalew Addis Alene
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hengzhong Yi
- Department of MDR-TB, Internal Medicine, Hunan Chest hospital, Changsha city, Hunan Province China
| | - Kerri Viney
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT Australia
- Centre for Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Emma S. McBryde
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD Australia
| | - Kunyun Yang
- Department of MDR-TB, Internal Medicine, Hunan Chest hospital, Changsha city, Hunan Province China
| | - Liqiong Bai
- Department of Director’s Office, Tuberculosis Control Institute of Hunan Province, Changsha city, Hunan Province China
| | - Darren J. Gray
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT Australia
| | - Archie C. A. Clements
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT Australia
| | - Zuhui Xu
- Department of Tuberculosis Control, Tuberculosis Control Institute of Hunan Province, Changsha city, Hunan Province China
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Ullah I, Javaid A, Masud H, Ali M, Basit A, Ahmad W, Younis F, Yasmin R, Khan A, Jabbar A, Husain M, Butt ZA. Rapid detection of Mycobacterium tuberculosis and rifampicin resistance in extrapulmonary tuberculosis and sputum smear-negative pulmonary suspects using Xpert MTB/RIF. J Med Microbiol 2017; 66:412-418. [PMID: 28425873 DOI: 10.1099/jmm.0.000449] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a serious public health problem in developing countries such as Pakistan. Rapid diagnosis of TB and detection of drug resistance are very important for timely and appropriate management of multidrug-resistant TB (MDR-TB). OBJECTIVE The purpose of this study was to determine the diagnostic efficacy of the Xpert MTB/RIF assay for rapid diagnosis of TB and detection of rifampicin (RIF) resistance in extrapulmonary and smear-negative pulmonary TB suspects. METHODS A total of 98 bronchoalveolar lavage fluid (BALF) and 168 extrapulmonary specimens were processed by Xpert MTB/RIF. Culture results are considered as the gold standard for diagnosis of TB, and drug susceptibility testing for detection of RIF resistance. Diagnostic efficacy was measured in terms of sensitivity, specificity and positive and negative predictive values. RESULTS The Xpert MTB/RIF assay detected 40 (40.8 %) of 98 BALF of presumptive pulmonary TB and 60 (35.7 %) of 168 extrapulmonary specimens. Sensitivity and specificity of the Xpert MTB/RIF assay for detection of TB was 86 and 88.4 %, respectively. The positive predictive value was 71.5 % while negative predictive value was 95.1 %. CONCLUSION The Xpert MTB/RIF assay is a rapid and simple technique with high sensitivity and specificity for diagnosing TB and detecting drug resistance in extrapulmonary and smear-negative TB cases.
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Affiliation(s)
- Irfan Ullah
- Programmatic Management of Drug resistant TB Unit, TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan.,Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Arshad Javaid
- Programmatic Management of Drug resistant TB Pulmonology, Lady Reading Hospital, Peshawar, Pakistan
| | - Haleema Masud
- Al-Shifa School of Public Health, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Mazhar Ali
- Programmatic Management of Drug resistant TB Pulmonology, Lady Reading Hospital, Peshawar, Pakistan
| | - Anila Basit
- Programmatic Management of Drug resistant TB Pulmonology, Lady Reading Hospital, Peshawar, Pakistan
| | - Waqas Ahmad
- Department of Mathematics, University of Science and Technology, Bannu, Pakistan
| | - Faisal Younis
- Programmatic Management of Drug resistant TB Unit, TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan
| | - Rehana Yasmin
- Department of Animal Sciences, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Afsar Khan
- Programmatic Management of Drug resistant TB Pulmonology, Lady Reading Hospital, Peshawar, Pakistan
| | - Abdul Jabbar
- Department of Medical lab Technology, University of Haripur, Haripur, Pakistan
| | - Masroor Husain
- Department of Biotechnology, University of Science and Technology, Bannu, Pakistan
| | - Zahid Ahmad Butt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Nair D, Velayutham B, Kannan T, Tripathy JP, Harries AD, Natrajan M, Swaminathan S. Predictors of unfavourable treatment outcome in patients with multidrug-resistant tuberculosis in India. Public Health Action 2017; 7:32-38. [PMID: 28775941 DOI: 10.5588/pha.16.0055] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 11/13/2016] [Indexed: 11/10/2022] Open
Abstract
Setting: India has one of the highest global rates of multidrug-resistant tuberculosis (MDR-TB), which is associated with poor treatment outcomes. A better understanding of the risk factors for unfavourable outcomes is needed. Objectives: To describe 1) the demographic and clinical characteristics of MDR-TB patients registered in three states of India during 2009-2011, 2) treatment outcomes, and 3) factors associated with unfavourable outcomes. Design: A retrospective cohort study involving a record review of registered MDR-TB patients. Results: Of 788 patients, 68% were male, 70% were aged 15-44 years, 90% had failed previous anti-tuberculosis treatment or were retreatment smear-positive, 60% had a body mass index < 18.5 kg/m2 and 72% had additional resistance to streptomycin and/or ethambutol. The median time from sputum collection to the start of MDR-TB treatment was 128 days (IQR 103-173). Unfavourable outcomes occurred in 40% of the patients, mostly from death or loss to follow-up. Factors significantly associated with unfavourable outcomes included male sex, age ⩾ 45 years, being underweight and infection with the human immunodeficiency virus. Adverse drug reactions were reported in 24% of patients, with gastrointestinal disturbance, psychiatric morbidity and ototoxicity the most common. Conclusion: Long delays from sputum collection to treatment initiation using conventional methods, along with poor treatment outcomes, suggest the need to scale up rapid diagnostic tests and shorter regimens for MDR-TB.
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Affiliation(s)
- D Nair
- Department of Clinical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - B Velayutham
- Department of Clinical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - T Kannan
- Department of Clinical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - J P Tripathy
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - A D Harries
- The Union, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - M Natrajan
- Department of Clinical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - S Swaminathan
- Indian Council of Medical Research, New Delhi, India
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Treatment outcome of new smear positive pulmonary tuberculosis patients in Hamadan, Iran: A registry-based cross-sectional study. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2016.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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19
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Javaid A, Khan MA, Khan MA, Mehreen S, Basit A, Khan RA, Ihtesham M, Ullah I, Khan A, Ullah U. Screening outcomes of household contacts of multidrug-resistant tuberculosis patients in Peshawar, Pakistan. ASIAN PAC J TROP MED 2016; 9:909-912. [PMID: 27633308 DOI: 10.1016/j.apjtm.2016.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 06/16/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To assess the profile of TB/multidrug-resistant TB (MDR-TB) among household contacts of MDR-TB patients. METHODS Close contacts of MDR-TB patients were traced in the cross-sectional study. Different clinical, radiological and bacteriological were performed to rule out the evidence of TB/MDR-TB. RESULTS Between January 2012 and December 2012, a total of 200 index MDR-TB patients were initiated on MDR-TB treatment, out of which home visit and contacts screening were conducted for 154 index cases. Of 610 contacts who could be studied, 41 (17.4%) were diagnosed with MDR-TB and 10 (4.2%) had TB. The most common symptoms observed were cough, chest pain and fever. CONCLUSIONS The high incidence of MDR-TB among close contacts emphasize the need for effective contact screening programme of index MDR-TB cases in order to cut the chain of transmission of this disease.
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Affiliation(s)
- Arshad Javaid
- Post Graduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan; Programmatic Management of Drug Resistant TB Unit, Lady Reading Hospital, Peshawar, Pakistan
| | - Mazhar Ali Khan
- Programmatic Management of Drug Resistant TB Unit, Lady Reading Hospital, Peshawar, Pakistan.
| | | | - Sumaira Mehreen
- Programmatic Management of Drug Resistant TB Unit, Lady Reading Hospital, Peshawar, Pakistan
| | - Anila Basit
- Post Graduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan; Programmatic Management of Drug Resistant TB Unit, Lady Reading Hospital, Peshawar, Pakistan
| | - Raza Ali Khan
- Kohat University of Science and Technology, Kohat, Pakistan
| | - Muhammad Ihtesham
- Programmatic Management of Drug Resistant TB Unit, Lady Reading Hospital, Peshawar, Pakistan
| | - Irfan Ullah
- Programmatic Management of Drug Resistant TB Unit, Lady Reading Hospital, Peshawar, Pakistan
| | - Afsar Khan
- Programmatic Management of Drug Resistant TB Unit, Lady Reading Hospital, Peshawar, Pakistan
| | - Ubaid Ullah
- Programmatic Management of Drug Resistant TB Unit, Lady Reading Hospital, Peshawar, Pakistan
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