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Nwachukwu NO, Ulasi AE, Okoronkwo CU, Unegbu VN. Pre-extensively drug-resistant tuberculosis among pulmonary multidrug-resistant tuberculosis patients in Eastern Nigeria. Lung India 2023; 40:492-495. [PMID: 37961955 PMCID: PMC10723212 DOI: 10.4103/lungindia.lungindia_337_23] [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: 06/28/2023] [Revised: 08/01/2023] [Accepted: 08/20/2023] [Indexed: 11/15/2023] Open
Abstract
Background Pre-extensively drug-resistant tuberculosis (Pre-XDR-TB), an emerging form of drug-resistant tuberculosis, is challenging efforts at tuberculosis control, leading to treatment failure among multidrug-resistant tuberculosis (MDR-TB) patients and progression to extensively drug-resistant tuberculosis (XDR-TB). We determined the rate of Pre-XDR-TB among multidrug-resistant patients in Southeast, Nigeria. Methods A prospective laboratory-based study was carried out at the South East Zonal Tuberculosis Reference Laboratory from January 2021 to December 2021. Second-line drug (SLD) resistance was performed on 225 sputum samples of multidrug-resistant patients prior to treatment initiation using GenoType MTBDRsl genotypic drug susceptibility testing (DST) method. Results The rate of Pre-XDR-TB among 225 MDR-TB cases was 3.1%. Fluoroquinolone-resistant Pre-XDR-TB was observed (100%) in previously treated tuberculosis cases. Only one (0.4%) case showed resistance to both fluoroquinolone (FQ) and one second-line injectable drug (XDR-TB). The extensively drug-resistant case observed was a de-novo resistance. Exactly 0.9% of the multidrug-resistant cases showed resistance to second-line injectables. Conclusion The prevalence of Pre-XDR-TB among MDR-TB cases was high. There is need for rapid detection of Pre-XDR-TB among MDR-TB cases before treatment initiation.
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Affiliation(s)
- Ndubuisi O. Nwachukwu
- Department of Medical Laboratory Science, Abia State University Uturu, P.M.B 2000, Uturu, Abia State, Nigeria
- Department of Microbiology, Abia State University Uturu, P.M.B 2000, Uturu, Nigeria
| | - Amara E. Ulasi
- Department of Animal and Environmental Biology, Abia State University Uturu, P.M.B 200b0, Uturu, Abia State, Nigeria
| | | | - Valentine N. Unegbu
- Department of Biology Science, University of Agriculture and Environmental Sciences, Umuagwo, Imo State, Nigeria
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Diriba G, Alemu A, Tola HH, Yenew B, Amare M, Eshetu K, Sinshaw W, Abebaw Y, Meaza A, Seid G, Moga S, Zerihun B, Getu M, Dagne B, Mollalign H, Tadesse M, Buta B, Wordofa N, Alemu E, Erresso A, Hailu M, Tefera Z, Wondimu A, Belhu T, Gamtesa DF, Getahun M, Kebede A, Abdela S. Pre-extensively drug-resistant tuberculosis among multidrug-resistant tuberculosis patients in Ethiopia: a laboratory-based surveillance study. IJID REGIONS 2022; 5:39-43. [PMID: 36176268 PMCID: PMC9513164 DOI: 10.1016/j.ijregi.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022]
Abstract
Background The rise of drug-resistant tuberculosis (DR-TB) has presented a substantial challenge to the national tuberculosis (TB) control program. Understanding the epidemiology of pre-extensively drug-resistant tuberculosis (pre-XDR-TB) could help clinicians to adapt MDR-TB treatment regimens at an earlier stage. This study aimed to assess second-line anti-TB drug resistance among MDR-TB patients in Ethiopia using routine laboratory-based data. Methods Laboratory-based cross-sectional data were collected from the national TB reference laboratory and seven regional tuberculosis culture laboratories in Ethiopia from July 2019 to March 2022. The required data, such as drug-susceptibility testing (DST) results and sociodemographics, were collected on a structured checklist from laboratory registration books and electronic databases. Data were entered into a Microsoft Excel spreadsheet and analyzed using SPSS version 23. Descriptive statistics were performed to show the distribution and magnitude of drug resistance. Results Second-line drugs (SLDs) susceptibility testing was performed for 644 MDR isolates, of which 19 (3%) were found to be pre-XDR-TB cases. Of the total MDR-TB isolates, 19 (3%) were resistant to at least one fluoroquinolone drug, while 11 (1.7%) were resistant to at least one injectable second-line drug. Of the 644 MDR-TB isolates, 1.9% (5/261) pre-XDR were from new MDR-TB cases, while 3.7% (14/383) were from previously treated MDR-TB patients. The most frequently identified mutations, based on MTBDRsl results, were in codon A90V of the gyrA gene (77.3%) and A1401G of the rrs gene (45.5%). Conclusion The overall prevalence of pre-XDR-TB in Ethiopia is considerable. The majority of SLD resistance mutations were in the gyrA gene at position A90V. Modern, rapid DST is necessary to enable identification of pre-XDR-TB and XDR-TB in supporting proper regimen administration for patients.
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Affiliation(s)
- Getu Diriba
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ayinalem Alemu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Bazezew Yenew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Misikir Amare
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kirubel Eshetu
- USAID Eliminate TB Project, Management Sciences for Health, Addis Ababa, Ethiopia
| | | | | | - Abyot Meaza
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Getachew Seid
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Shewki Moga
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Melak Getu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Biniyam Dagne
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | - Bedo Buta
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Niguse Wordofa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ephrem Alemu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Michael Hailu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Zigba Tefera
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Tegegn Belhu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | - Abebaw Kebede
- Africa Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Saro Abdela
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Synthesis and in vitro studies for structure-based design of novel chalcones as antitubercular agents targeting InhA. Future Med Chem 2022; 14:851-866. [PMID: 35548879 DOI: 10.4155/fmc-2022-0052] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: The authors aimed to estimate the therapeutic potential of novel chalcones against tuberculosis. Methods: 11 synthesized compounds were tested for in vitro antimycobacterial activity against Mycobacterium tuberculosis (H37RV; American Type Culture Collection number: 27294) using the microplate alamarBlue assay. Molecular docking and pharmacokinetic parameter analyses were then performed. Results: The most potent compounds, (2E)-1-(4-bromophenyl) (2E)-1-(2-nitrophenyl) prop-2-en-1-one, -3-(2-nitrophenyl) prop-2-en-1-one (4-bromophenyl) (2E)-1-(3-phenoxyphenyl)prop-2-en-1-one, 3-(phenoxyphenyl)prop-2-en-1-one (4-bromophenyl) prop-2-en-1-one and (2E)-1-(4-bromophenyl)-3-(5-chloro-2-hydroxyphenyl)-prop-2-en-1-one, showed in vitro activity, with a minimum inhibitory concentration (MIC) of 6.25 μg/ml. Conclusion: Compounds LSD2, LSD12, LSD13 and LSD15 showed strong in vitro antimycobacterial activity at a concentration of 6.25 μg/ml.
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Mujuni D, Kasemire DL, Ibanda I, Kabugo J, Nsawotebba A, Phelan JE, Majwala RK, Tugumisirize D, Nyombi A, Orena B, Turyahabwe I, Byabajungu H, Nadunga D, Musisi K, Joloba ML, Ssengooba W. Molecular characterisation of second-line drug resistance among drug resistant tuberculosis patients tested in Uganda: a two and a half-year's review. BMC Infect Dis 2022; 22:363. [PMID: 35410160 PMCID: PMC9003953 DOI: 10.1186/s12879-022-07339-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 04/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Second-line drug resistance (SLD) among tuberculosis (TB) patients is a serious emerging challenge towards global control of the disease. We characterized SLD-resistance conferring-mutations among TB patients with rifampicin and/or isoniazid (RIF and/or INH) drug-resistance tested at the Uganda National TB Reference Laboratory (NTRL) between June 2017 and December 2019. METHODS This was a descriptive cross-sectional secondary data analysis of 20,508 M. tuberculosis isolates of new and previously treated patients' resistant to RIF and/or INH. DNA strips with valid results to characterise the SLD resistance using the commercial Line Probe Assay Genotype MTBDRsl Version 2.0 Assay (Hain Life Science, Nehren, Germany) were reviewed. Data were analysed with STATAv15 using cross-tabulation for frequency and proportions of known resistance-conferring mutations to injectable agents (IA) and fluoroquinolones (FQ). RESULTS Among the eligible participants, 12,993/20,508 (63.4%) were male and median (IQR) age 32 (24-43). A total of 576/20,508 (2.8%) of the M. tuberculosis isolates from participants had resistance to RIF and/or INH. These included; 102/576 (17.7%) single drug-resistant and 474/576 (82.3%) multidrug-resistant (MDR) strains. Only 102 patients had test results for FQ of whom 70/102 (68.6%) and 01/102 (0.98%) had resistance-conferring mutations in the gyrA locus and gyrB locus respectively. Among patients with FQ resistance, gyrAD94G 42.6% (30.0-55.9) and gyrA A90V 41.1% (28.6-54.3) mutations were most observed. Only one mutation, E540D was detected in the gyrB locus. A total of 26 patients had resistance-conferring mutations to IA in whom, 20/26 77.0% (56.4-91.0) had A1401G mutation in the rrs gene locus. CONCLUSIONS Our study reveals a high proportion of mutations known to confer high-level fluoroquinolone drug-resistance among patients with rifampicin and/or isoniazid drug resistance. Utilizing routinely generated laboratory data from existing molecular diagnostic methods may aid real-time surveillance of emerging tuberculosis drug-resistance in resource-limited settings.
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Affiliation(s)
- Dennis Mujuni
- Makerere University, College of Health Sciences, Kampala, Uganda.,World Health Organisation Supranational Reference Laboratory, Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Dianah Linda Kasemire
- World Health Organisation Supranational Reference Laboratory, Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Ivan Ibanda
- Department of Pharmacology and Toxicology, School of Pharmacy, Kampala International University, Kampala, Uganda
| | - Joel Kabugo
- World Health Organisation Supranational Reference Laboratory, Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Andrew Nsawotebba
- World Health Organisation Supranational Reference Laboratory, Uganda National TB Reference Laboratory, Kampala, Uganda.,National Health Laboratory and Diagnostic Services, Kampala, Uganda
| | - Jody E Phelan
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Robert Kaos Majwala
- United States Agency for International Development, Defeat TB Project, Kampala, Uganda
| | - Didas Tugumisirize
- World Health Organisation Supranational Reference Laboratory, Uganda National TB Reference Laboratory, Kampala, Uganda.,National Tuberculosis and Leprosy Control Programme, Ministry of Health, Kampala, Uganda
| | - Abdunoor Nyombi
- World Health Organisation Supranational Reference Laboratory, Uganda National TB Reference Laboratory, Kampala, Uganda.,National Tuberculosis and Leprosy Control Programme, Ministry of Health, Kampala, Uganda
| | - Beatrice Orena
- World Health Organisation Supranational Reference Laboratory, Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Irene Turyahabwe
- World Health Organisation EPI Laboratory, Uganda Virus Research Institute, Entebbe, Uganda
| | - Henry Byabajungu
- World Health Organisation Supranational Reference Laboratory, Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Diana Nadunga
- World Health Organisation Supranational Reference Laboratory, Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Kenneth Musisi
- World Health Organisation Supranational Reference Laboratory, Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Moses Lutakoome Joloba
- World Health Organisation Supranational Reference Laboratory, Uganda National TB Reference Laboratory, Kampala, Uganda.,Department of Medical Microbiology, School of Biomedical Sciences, Makerere University, Kampala, Uganda
| | - Willy Ssengooba
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University, Kampala, Uganda. .,Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda.
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Novel mutations detected from drug resistant Mycobacterium tuberculosis isolated from North East of Thailand. World J Microbiol Biotechnol 2021; 37:194. [PMID: 34642828 DOI: 10.1007/s11274-021-03163-7] [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: 06/22/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
The emergence of drug-resistant tuberculosis is a major global public health threat. Thailand is one of the top 14 countries with high tuberculosis and multi-drug resistant tuberculosis rates. Immediate detection of drug-resistant tuberculosis is necessary to reduce mortality and morbidity by effectively providing treatment to ameliorate the formation of resistant strains. Limited data exist of mutation profiles in Northeastern Thailand. Here, 65 drug-resistant Mycobacterium tuberculosis isolates were used to detect mutations by polymerase chain reaction (PCR) and DNA sequencing. In the katG gene, mutations were occurred in 47 (79.7%) among 59 isoniazid resistant samples. For rpoB gene, 31 (96.9%) were observed as mutations in 32 rifampicin resistant isolates. Of 47 katG mutation samples, 45 (95.7%) had mutations in katG315 codon and 2 (4.3%) showed novel mutations at katG365 with amino acid substitution of CCG-CGG (Pro-Arg). Moreover, out of 31 rpoB mutation isolates, the codon positions rpoB516, rpoB526, rpoB531 and rpoB533 were 3 (9.7%), 8 (25.8%), 11 (35.5%) and 1 (3.2%), respectively. Seven isolates of double point mutation were found [rpoB516, 526; 1 (3.2%) and rpoB516, 531; 6 (19.4%)]. In addition, 1 (3.2%) sample had triple point mutation at codon positions rpoB516, 526 and 531. Common and novel mutation codons of the rpoB and katG genes were generated. Although DNA sequencing showed high accuracy, conventional PCR could be applied as an initial marker for screening drug-resistant Mycobacterium tuberculosis isolates in limit resources region. Mutations reported here should be considered when developing new molecular diagnostic methods for implementation in Northeastern Thailand.
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