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Admassu F, Abera E, Gizachew A, Sedoro T, Gari T. Risk factors of multidrug resistant tuberculosis among patients with tuberculosis at selected multidrug resistance treatment initiative centres in southern Ethiopia: a case-control study. BMJ Open 2023; 13:e061836. [PMID: 36639214 PMCID: PMC9843192 DOI: 10.1136/bmjopen-2022-061836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To identify the risk factors for multidrug resistant tuberculosis (MDR-TB) among patients with TB at selected MDR-TB treatment initiative centres, southern Ethiopia, 2021. DESIGN An unmatched case-control study was employed. SETTING Multidrug resistance treatment initiative centres in southern Ethiopia (Nigist Elen Mohamed Memorial Comprehensive Specialized Hospital and Butajira General Hospital). PARTICIPANTS A total sample size of 392 (79 cases and 313 controls) were selected by the systematic sampling technique. Cases were all patients with TB with culture proven or line probe assay confirmed Mycobacterium tuberculosis resistant to at least both isoniazid and rifampicin and registered on second-line TB treatment. Controls were all patients with bacteriological (molecular) proven drug-susceptible TB strains and whose recent smear results were turned to negative and registered as cured. Both bivariate and multivariable logistic regression analysis was used to identify risk factors of MDR-TB infections. MAIN OUTCOME MEASURE Identifying the risk factors for MDR-TB. RESULTS A total of 392 participants (79 cases and 313 controls) were interviewed. Multivariable analysis showed that direct contact with known patients with TB (AOR =4.35; 95% CI: 1.45 to 9.81), history of previous TB treatment (AOR=2.51; 95% CI: 1.50 to 8.24), history of cigarette smoking (AOR=3.24; 95% CI :2.17 to 6.91) and living in rural area (AOR=4.71; 95% CI :3.13 to 9.58) were identified risk factors for MDR-TB infections. CONCLUSIONS The study findings revealed that direct contact with known patients with TB, previous history of TB treatment, history of cigarette smoking and rural residence were potential risk factors for the occurrence of MDR-TB. In order to reduce the burden of drug resistance, strategies of controlling MDR-TB in the study area should emphasise on enhancing public health education and reducing treatment interruptions of patients with TB and drug-resistant TB.
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Affiliation(s)
| | - Ermias Abera
- Department of Epidemiology and Biostatistics, Wachemo University, Hossana, SNNPR, Ethiopia
| | - Addisalem Gizachew
- Department of Public Health, Wachemo University, Hossana, SNNPR, Ethiopia
| | - Tagesse Sedoro
- Department of Public Health, Wachemo University, Hossana, SNNPR, Ethiopia
| | - Taye Gari
- Department of Epidemiology and Biostatistics, Hawassa University, Hawassa, Sidama, Ethiopia
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Rayamajhi P, Nepal G, Ojha R, Rajbhandari R, Gajurel BP, Karn R. Evaluating cognitive outcomes in adult patients with acute encephalitis syndrome: a prospective study from a tertiary care center in Nepal. ENCEPHALITIS 2022; 2:36-44. [PMID: 37469649 PMCID: PMC10295914 DOI: 10.47936/encephalitis.2021.00157] [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: 09/18/2021] [Revised: 10/22/2021] [Accepted: 11/08/2021] [Indexed: 07/21/2023] Open
Abstract
Purpose Although cognitive impairment is a known complication of acute encephalitis syndrome (AES), few studies have evaluated cognitive outcomes in patients with encephalitis. The primary objective of this study was to assess the cognitive profiles of patients diagnosed with AES, which is pivotal for improving rehabilitation strategies and prognostic measures. Methods This study was conducted at the Tribhuvan University Teaching Hospital. Adult patients with AES who met inclusion criteria were enrolled. The Montreal Cognitive Assessment (MoCA) tool was used to assess cognitive function at admission, discharge, and 3-month follow-up. Results Thirty-six patients were enrolled in our study. The mean age of the participants was 43 ± 18 years. Fourteen patients (38.9%) were female, and 22 (61.1%) were male. Tuberculous (TB) meningoencephalitis was present in 14 cases (38.9%), with herpes simplex virus (HSV) encephalitis in 14 (38.9%), bacterial meningoencephalitis in 4 (11.1%), autoimmune encephalitis in 2 (5.6%), and Japanese encephalitis in 2 (5.6%). Patients with bacterial meningoencephalitis had the highest MoCA scores at admission, whereas those with HSV encephalitis had the highest scores at discharge and follow-up. Compared with the scores at admission, the scores at discharge and follow-up increased significantly in patients with TB meningoencephalitis and HSV encephalitis. The MoCA score at discharge was established as a significant predictor of cognitive function at follow-up. Conclusion We found that active treatment can improve the outcomes of AES patients with cognitive impairment. Although infectious etiologies are most common in low-income countries such as Nepal, autoimmune etiologies should not be overlooked.
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Affiliation(s)
- Parash Rayamajhi
- Department of Neurology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Gaurav Nepal
- Department of Internal Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Rajeev Ojha
- Department of Neurology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Reema Rajbhandari
- Department of Neurology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | - Ragesh Karn
- Department of Neurology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Iradukunda A, Ndayishimiye GP, Sinarinzi D, Odjidja EN, Ntakaburimvo N, Nshimirimana I, Izere C. Key factors influencing multidrug-resistant tuberculosis in patients under anti-tuberculosis treatment in two centres in Burundi: a mixed effect modelling study. BMC Public Health 2021; 21:2142. [PMID: 34814876 PMCID: PMC8609742 DOI: 10.1186/s12889-021-12233-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 11/11/2021] [Indexed: 11/21/2022] Open
Abstract
Background Despite the World Health Organization efforts to expand access to the tuberculosis treatment, multidrug resistant tuberculosis (MDR-TB) remains a major threat. MDR-TB represents a challenge for clinicians and staff operating in national tuberculosis (TB) programmes/centres. In sub-Saharan African countries including Burundi, MDR-TB coexists with high burden of other communicable and non-communicable diseases, creating a complex public health situation which is difficult to address. Tackling this will require targeted public health intervention based on evidence which well defines the at-risk population. In this study, using data from two referral anti-tuberculosis in Burundi, we model the key factors associated with MDR-TB in Burundi. Methods A case-control study was conducted from 1stAugust 2019 to 15th January 2020 in Kibumbu Sanatorium and Bujumbura anti-tuberculosis centres for cases and controls respectively. In all, 180 TB patients were selected, comprising of 60 cases and 120 controls using incidence density selection method. The associated factors were carried out by mixed effect logistic regression. Model performance was assessed by the Area under Curve (AUC). Model was internally validated via bootstrapping with 2000 replications. All analysis were done using R Statistical 3.5.0. Results MDR-TB was more identified among patients who lived in rural areas (51.3%), in patients’ residence (69.2%) and among those with a household size of six or more family members (59.5%). Most of the MDR-TB cases had already been under TB treatment (86.4%), had previous contact with an MDR-TR case (85.0%), consumed tobacco (55.5%) and were diabetic (66.6 %). HIV prevalence was 32.3 % in controls and 67.7 % among cases. After modelling using mixed effects, Residence of patients (aOR= 1.31, 95%C: 1.12-1.80), living in houses with more than 6 family members (aOR= 4.15, 95% C: 3.06-5.39), previous close contact with MDR-TB (aOR= 6.03, 95% C: 4.01-8.12), history of TB treatment (aOR= 2.16, 95% C: 1.06-3.42), tobacco consumption (aOR = 3.17 ,95% C: 2.06-5.45) and underlying diabetes’ ( aOR= 4.09,95% CI = 2.01-16.79) were significantly associated with MDR-TB. With 2000 stratified bootstrap replicates, the model had an excellent predictive performance, accurately predicting 88.15% (95% C: 82.06%-92.8%) of all observations. The coexistence of risk factors to the same patients increases the risk of MDR-TB occurrence. TB patients with no any risk factors had 17.6% of risk to become MDR-TB. That probability was respectively three times and five times higher among diabetic and close contact MDR-TB patients. Conclusion The relatively high TB’s prevalence and MDR-TB occurrence in Burundi raises a cause for concern especially in this context where there exist an equally high burden of chronic diseases including malnutrition. Targeting interventions based on these identified risk factors will allow judicious channel of resources and effective public health planning. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12233-2.
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Affiliation(s)
- Arnaud Iradukunda
- Department of Medicine, University of Burundi, Bujumbura, PB 1550, Burundi. .,Department of Statistics, Lake Tanganyika University, Mutanga, PB 5304, Burundi. .,Royal Society of Tropical Medicine and hygiene, 303-306 High Holborn, London, UK.
| | | | - Darlene Sinarinzi
- Department of Statistics, Lake Tanganyika University, Mutanga, PB 5304, Burundi
| | - Emmanuel Nene Odjidja
- Royal Society of Tropical Medicine and hygiene, 303-306 High Holborn, London, UK.,Department of Medicine, School of Clinical Sciences, Monash University, Wellington Rd, Clayton, VIC, 3800, Australia
| | - Nestor Ntakaburimvo
- Department of Statistics, Lake Tanganyika University, Mutanga, PB 5304, Burundi
| | | | - Cheilla Izere
- Department of Computer Mathematics, Clermont Auvergne University, PB 63000, Clermont-Ferrand, France
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Dixit K, Biermann O, Rai B, Aryal TP, Mishra G, Teixeira de Siqueira-Filha N, Paudel PR, Pandit RN, Sah MK, Majhi G, Levy J, Rest JV, Gurung SC, Dhital R, Lönnroth K, Squire SB, Caws M, Sidney K, Wingfield T. Barriers and facilitators to accessing tuberculosis care in Nepal: a qualitative study to inform the design of a socioeconomic support intervention. BMJ Open 2021; 11:e049900. [PMID: 34598986 PMCID: PMC8488704 DOI: 10.1136/bmjopen-2021-049900] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 09/10/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Psychosocial and economic (socioeconomic) barriers, including poverty, stigma and catastrophic costs, impede access to tuberculosis (TB) services in low-income countries. We aimed to characterise the socioeconomic barriers and facilitators of accessing TB services in Nepal to inform the design of a locally appropriate socioeconomic support intervention for TB-affected households. DESIGN From August 2018 to July 2019, we conducted an exploratory qualitative study consisting of semistructured focus group discussions (FGDs) with purposively selected multisectoral stakeholders. The data were managed in NVivo V.12, coded by consensus and analysed thematically. SETTING The study was conducted in four districts, Makwanpur, Chitwan, Dhanusha and Mahottari, which have a high prevalence of poverty and TB. PARTICIPANTS Seven FGDs were conducted with 54 in-country stakeholders, grouped by stakeholders, including people with TB (n=21), community stakeholders (n=13) and multidisciplinary TB healthcare professionals (n=20) from the National TB Programme. RESULTS The perceived socioeconomic barriers to accessing TB services were: inadequate TB knowledge and advocacy; high food and transportation costs; income loss and stigma. The perceived facilitators to accessing TB care and services were: enhanced championing and awareness-raising about TB and TB services; social protection including health insurance; cash, vouchers and/or nutritional allowance to cover food and travel costs; and psychosocial support and counselling integrated with existing adherence counselling from the National TB Programme. CONCLUSION These results suggest that support interventions that integrate TB education, psychosocial counselling and expand on existing cash transfer schemes would be locally appropriate and could address the socioeconomic barriers to accessing and engaging with TB services faced by TB-affected households in Nepal. The findings have been used to inform the design of a socioeconomic support intervention for TB-affected households. The acceptability, feasibility and impact of this intervention on TB-related costs, stigma and TB treatment outcomes, is now being evaluated in a pilot implementation study in Nepal.
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Affiliation(s)
- Kritika Dixit
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
| | - Olivia Biermann
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
| | - Bhola Rai
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
| | - Tara Prasad Aryal
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
| | - Gokul Mishra
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Noemia Teixeira de Siqueira-Filha
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Health Sciences, University of York, York, UK
| | - Puskar Raj Paudel
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
- KNCV Tuberculosis Foundation, Den Haag, The Netherlands
| | - Ram Narayan Pandit
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
| | - Manoj Kumar Sah
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
| | - Govinda Majhi
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
| | - Jens Levy
- KNCV Tuberculosis Foundation, Den Haag, The Netherlands
| | - Job van Rest
- KNCV Tuberculosis Foundation, Den Haag, The Netherlands
| | - Suman Chandra Gurung
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Raghu Dhital
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
| | - Knut Lönnroth
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
| | - S Bertel Squire
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Maxine Caws
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kristi Sidney
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
| | - Tom Wingfield
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
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Shivekar SS, Kaliaperumal V, Brammacharry U, Sakkaravarthy A, Raj CKV, Alagappan C, Muthaiah M. Prevalence and factors associated with multidrug-resistant tuberculosis in South India. Sci Rep 2020; 10:17552. [PMID: 33067551 PMCID: PMC7567814 DOI: 10.1038/s41598-020-74432-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 09/18/2020] [Indexed: 12/13/2022] Open
Abstract
India accounts for about one-fourth of the global burden of MDR-TB. This study aims to assess the prevalence and factors associated with tuberculosis drug resistance among patients from South India. MTBDRplus assay and MGIT liquid culture performed on 20,245 sputum specimens obtained from presumptive MDR-TB cases during a six-year period from 2013 to 2018 were analyzed retrospectively. Univariate and multivariate logistic regression analysis was carried out to evaluate factors associated with MDR, Rifampicin mono-resistance, and Isoniazid mono-resistance. MDR, Rifampicin mono- resistant and Isoniazid mono-resistant TB were found in 5.4%, 2.5%, and 11.4% cases of presumptive MDR-TB, respectively. Based on the rpoB gene, true resistance, hetero-resistance, and inferred resistance to Rifampicin was found in 38%, 29.3%, and 32.7% of the 1582 MDR cases, respectively. S450L (MUT3) was the most common rpoB mutation present in 59.4% of the Rifampicin resistant cases. Of the 3390 Isoniazid resistant cases, 72.5% had mutations in the katG gene, and 27.5% had mutations in the inhA gene. True resistance, heteroresistance, and inferred resistance accounted for 42.9%, 22.2%, and 17.3% of the 2459 katG resistant cases, respectively. True resistance, heteroresistance, and inferred resistance for the inhA gene were found in 54.5%, 40.7%, and 4.7% cases, respectively. MDR-contact (AOR 3.171 95% CI: 1.747–5.754, p-0.000) treatment failure (AOR 2.17595% CI: 1.703–2.777, p-0.000) and female gender (AOR 1.315 95% CI: 1.117–1.548, p-0.001), were positively associated with MDR-TB. Previous TB treatment did not show a significant positive association with MDR (AOR 1.113 95% CI: 0.801–1.546, p-0.523). Old age (AOR 0.994 95% CI: 0.990–0.999, p-0.023) and HIV seropositivity (AOR 0.580 95% CI: 0.369–0.911, p-0.018) were negatively associated with MDR-TB. Although Rifampicin mono-resistance had a positive association with treatment failure (AOR 2.509 95% CI: 1.804–3.490, p < .001), it did not show any association with previous TB treatment (AOR 1.286 95% CI: 0.765–2.164, p-0.342) or with history of contact with MDR-TB (AOR 1.813 95% CI: 0.591–5.560, p-0.298). However, INH mono-resistance showed a small positive association with the previous history of treatment for TB (AOR 1.303 95% CI: 1.021–1.662, p-0.033). It was also positively associated (AOR 2.094 95% CI: 1.236–3.548, p-0.006) with MDR-TB contacts. Thus INH resistance may develop during treatment if compliance has not adhered too and may be easily passed on to the contacts while Rifampicin resistance is probably due to factors other than treatment compliance. MDR-TB, i.e. resistance to both Rifampicin and Isoniazid, is strongly correlated with treatment failure, spread through contact, and not to treatment compliance. The temporal trend in this region shows a decrease in MDR prevalence from 8.4% in 2015 to 1.3% in 2018. A similar trend is observed for Rifampicin mono-resistance and Isoniazid mono-resistance, pointing to the effectiveness of the TB control program. The higher proportion of inferred resistance observed for Rifampicin compared with INH may indicate a surfeit of mechanisms that enable rifampicin resistance. Association of MDR-TB with age, gender, and HIV status suggest the role of the immune system in the emergence of the MDR phenotype.
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Affiliation(s)
- Smita S Shivekar
- Department of Microbiology, State TB Training and Demonstration Centre, Government Hospital for Chest Diseases, Puducherry, India
| | - Venkatesh Kaliaperumal
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Usharani Brammacharry
- Department of Genetics, Dr.A.L.M. Postgraduate Institute of Basic Medical Sciences, University of Madras, Tamil Nadu, Chennai, India.
| | | | - C K Vidya Raj
- Department of Microbiology, State TB Training and Demonstration Centre, Government Hospital for Chest Diseases, Puducherry, India
| | - Chitra Alagappan
- Department of Microbiology, State TB Training and Demonstration Centre, Government Hospital for Chest Diseases, Puducherry, India
| | - Muthuraj Muthaiah
- Department of Microbiology, State TB Training and Demonstration Centre, Government Hospital for Chest Diseases, Puducherry, India.
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Song WM, Li YF, Ma XB, Liu JY, Tao NN, Liu Y, Zhang QY, Xu TT, Li SJ, Yu CB, Gao L, Cui LL, Li HC. Primary drug resistance of mycobacterium tuberculosis in Shandong, China, 2004-2018. Respir Res 2019; 20:223. [PMID: 31627757 PMCID: PMC6798379 DOI: 10.1186/s12931-019-1199-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary drug-resistant tuberculosis (DR-TB) has contributed to a significant health and economic burden on a global scale, especially in China. we sought to estimate epidemiological characteristics of primary DR-TB in China from 2004 to 2018. METHODS Eleven thousand four hundred sixty-seven newly diagnosed and 1981 retreated TB cases with drug susceptibility data were included. Chi-Square test for trends, linear regression, a joinpoint regression model and temporal trend in proportions of the different resistance patterns were carried out. RESULTS The proportion of primary DR-TB and mono-resistant TB (MR-TB) in China had reduced by more than 12% since 2004, and were 21.38%, 13.35% in 2018 respectively. Among primary DR-TB cases (2173,18.95%), the percentage of multiresistant TB (MDR-TB, from 5.41 to 17.46%), male (from 77.03 to 84.13%), cavity (from 13.51 to 43.92%), rifampicin(RFP)-resistant TB (from 8.11 to 26.98%), streptomycin(SM)-resistant TB (from 50.00 to 71.43%) increased significantly (P < 0.05). On the contrary, the proportion of female, non-cavity, isoniazide(INH)-resistant TB (from 55.41 to 48.15%) and MR-TB (from 82.43 to 62.43%) decreased significant (P < 0.05). The primary drug resistance rate among female, cavity, smoking, drinking, 15 to 44 year-old TB subgroups increased by 0.16, 6.24, 20.95, 158.85, 31.49%, respectively. The percentage of primary DR-TB, RFP-resistant TB dropped significantly during 2004-2007 in Joinpoint regression model. CONCLUSION The total rate of drug resistance among new TB cases showed a downward trend in Shandong, China, from 2004 to 2018. Primary drug resistance patterns were shifting from female, non-cavity, INH-resistant TB, and MR-TB groups to male, cavity, RFP/SM-resistant TB, and MDR-TB groups. Considering the rising drug resistance rate among some special population, future control of primary DR-TB in China may require an increased focus on female, cavity, smoking, drinking, or 15 to 44 year-old TB subgroups.
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Affiliation(s)
- Wan-Mei Song
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong, China.,Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Yi-Fan Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong, China
| | - Xiao-Bin Ma
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong, China
| | - Jin-Yue Liu
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, 250200, Shandong, China
| | - Ning-Ning Tao
- Peking Union Medical College, Beijing, 100005, China
| | - Yao Liu
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong, China
| | - Qian-Yun Zhang
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong, China.,Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Ting-Ting Xu
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong, China
| | - Shi-Jin Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong, China.,Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Chun-Bao Yu
- Department of Respiratory Medicine, Shandong Provincial Chest Hospital, Jinan, 250013, Shandong, China
| | - Lei Gao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Liang-Liang Cui
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, 250012, Shandong, China.,Jinan Municipal Center for Disease Control and Prevention, Jinan, 250021, Shandong, China
| | - Huai-Chen Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong, China. .,Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China.
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Sharma M, Roy N, Banerjee R, Kishore J, Jakhar A. Determinants of Drug Resistance in Previously-Treated Pulmonary Tuberculosis Patients Registered at a Chest Clinic in South Delhi, India. Cureus 2019; 11:e5541. [PMID: 31523588 PMCID: PMC6721924 DOI: 10.7759/cureus.5541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction Drug-resistant tuberculosis (DR-TB) is a major concern to effective control of tuberculosis (TB) in India and the likelihood of drug resistance increases with repeated exposure to anti-TB drugs. India has emerged as one of the leading contributors of DR-TB in the world posing a major threat to TB control. In the current study, we aim to find the burden and factors associated with drug resistance in previously treated pulmonary TB patients. Methods A cross-sectional study was conducted among 230 previously treated pulmonary TB patients registered with Directly Observed Treatment, Short-course (DOTS) centers under Nehru Nagar Chest clinic in Delhi, India. The participants were selected consecutively as they registered with the chest clinic. A predesigned, pretested, semi-structured questionnaire in the Hindi language used to collect socio-demographic data and factors associated with the development of drug resistance. Physical examination of all the participants was done (height, weight, pallor). Data were analyzed using SPSS version 21. Binary logistic regression analysis was used to identify independent risk factors of drug resistance. Results Of 230 previously treated pulmonary TB patients, 80 (34.8% (95% CI:28.7-40.9%)) were drug-resistant. Age (p=0.021), ever consumption of alcohol (p= 0.001), pallor (p=0.06), BMI (p=0.028), fasting blood sugar (p=0.001), treatment failure (p=0.005) and the number of prior courses of anti-tuberculosis treatment (ATT) taken (p=0.004) were significantly associated with drug resistance. On applying binary logistic regression analysis, independently associated factors with drug resistance were ever consumption of alcohol, pallor, high fasting blood sugar level, previous treatment failure patients and the number of prior courses of ATT (p<0.05). Conclusion The findings of this study revealed that patients who had pallor, high fasting blood sugar, treatment failure and who had two or more prior courses of ATT were more likely to have DR-TB. Identifying the risk factors for drug-resistant TB is essential in facilitating the government to draw public health interventions. Further research is warranted to explore the causal associations.
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Affiliation(s)
- Manila Sharma
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Neelam Roy
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Rupsa Banerjee
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Jugal Kishore
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Ashok Jakhar
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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Predictors of Multidrug-Resistant Tuberculosis (MDR-TB) in Sudan. Antibiotics (Basel) 2019; 8:antibiotics8030090. [PMID: 31323935 PMCID: PMC6783989 DOI: 10.3390/antibiotics8030090] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 01/17/2023] Open
Abstract
Multidrug-resistant tuberculosis (MDR-TB) is a global public health threat and burden on the health system. This is especially the case in high tuberculosis (TB) prevalence countries, such as Sudan. Consequently, this study aimed to ascertain the predictors of MDR-TB in Sudan to provide future guidance. An unmatched case-control study to assess the predictors of MDR-TB infections among the Sudanese population was conducted from August 2017 to January 2018 at Abu-Anga referral hospital. Patients’ data was gathered from patients’ cards and via interviews. A structured pre-validated questionnaire was used to gather pertinent information, which included sociodemographic characteristics and other relevant clinical data. Univariate and multivariate logistic regression analysis was employed to determine the predictors of MDR-TB infection. 76 of the 183 patients interviewed (41.5%) had MDR-TB cases. The independent predictors for MDR-TB were living in rural areas [adjusted odds ratio (aOR) = 3.1 (95% confidence interval (CI): 1.2–8.2)], treatment failure [aOR = 56.9 (10.2–319.2)], and smoking [(aOR = 4 (1.2–13.2)], whereas other sociodemographic factors did not predict MDR-TB. In conclusion, the study showed that a history of smoking, living in rural areas, and a previous treatment failure were the predictors of MDR-TB in Sudan. The latter factors are most likely due to issues that are related to access and adherence to treatment and lifestyle. The existence of any of these factors among newly diagnosed TB patients should alert clinicians for the screening of MDR-TB. The implementation of directly observed treatment (DOT) and health education are crucial in stopping the spread of MDR-TB in Sudan.
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Saleh S. FACTOR RELEATED OF ANTI-TUBERCULOSIS DRUG RESISTENCY ON PULMONARY TUBERCULOSIS PASIENT IN LABUANG BAJI HOSPITAL MAKASSAR. INDONESIAN JOURNAL OF TROPICAL AND INFECTIOUS DISEASE 2018. [DOI: 10.20473/ijtid.v7i2.7327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tuberculosis is one of the infectious diseases that endanger health. The diseases can spread rapidly since it spreads through the air that happens when people suffering from tuberculosis are coughing and sneezing so that droplets containing Mycobacterium tuberculosis can be exposed to anyone who was around the patient. The general objective of this research is to analyze the factors that affect the anti-tuberculosis drug resistance in patients with pulmonary tuberculosis in hospitals Labuang Makassar Baji.Research design with cross sectional approach. This study was conducted in June-July 2017. With a total sample of 60 respondents based on inclusion and exclusion criteria. Based on the data analysis, it was found that the age group of 15-34 years were 34 respondents (56,7%), female were 35 respondents (58.3%), positive VCT test result was 15 respondents (25.0%), respondents who have medical history previously there were 54 respondents (90.0%), who had 45 respondents (78.3%) of TB contacts, who had good knowledge as many as 45 respondents (75.6%) who had PMO as many as 40 respondents (66.7%) , which states the behavior of good officers as much as 36 respondents (60.0%).The result of statistical test using Chi-Square test showed that there was a significant correlation between treatment history and OAT resistance with p = 0,024 <α = 0,05. While age, HIV infection, TB contact, Knowledge, Attitude behavior, and PMO have no significant relationship with OAT resistance. It is recommended to health care agencies to provide understanding to patients and families about TB treatment to prevent OAT resistance. Keywords Tuberculosis, Resistance, Anti Tuberculosis Medication
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Gobena D, Ameya G, Haile K, Abreha G, Worku Y, Debela T. Predictor of multidrug resistant tuberculosis in southwestern part of Ethiopia: a case control study. Ann Clin Microbiol Antimicrob 2018; 17:30. [PMID: 29970076 PMCID: PMC6029339 DOI: 10.1186/s12941-018-0283-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/26/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Curable disease tuberculosis is becoming incurable or difficult to treat due to drug resistance. Multi drug resistance tuberculosis is a major health problem for less developed countries. Development of drug resistance is mainly as result of man related factors and poor lifestyle. Identifying predictors of drug resistance and working on them is the important way of reducing the expansion in high burden countries. Ethiopia is one of TB, TB/HIV, and multi-drug resistant tuberculosis (MDR-TB) high burden country globally. This study was aimed to assess predictor of MDR-TB in southwest part of Ethiopia. METHODS Unmatched case control study was conducted in case to control ratio of 1:1.2 in southwest part of Ethiopia. The cases were recruited from confirmed MDR-TB patient enrolled on second line treatment in Shenen Gibe Hospital (MDR-TB treatment center of the prefecture) and the controls were recruited from previously TB patients who cured or patient with smear negative at the end of treatment month during the study period in the same area. The data was collected by structured questionnaire by interview and logistic regression analyses were used to identify predictors of MDR-TB. Odds ratios with 95% CI were computed to determine the predictors. RESULT From the total 132 participants about 45% of them were cases. None disclosed tuberculosis infected to relatives [AOR = 3.4, 95% CI (1.2-9.8)], insufficient instruction on how to take anti-TB drug [AOR = 4.7, 95% CI (1.4-14.6)], contact history with MDR-TB [AOR = 8.5, 95% CI (2.9-25.5)], interruption of first-line anti-TB treatment for at list 1 day [AOR = 7.9, 95% CI (2.5-24.9)], and having alcohol drinking habits [AOR = 5.1, 95% CI (1.4-18.7)] were identified predictors for MDR-TB infection in study area. CONCLUSION TB infection disclosure status, insufficient instruction on drug usage, contact history with MDR-TB, interruption of first-line anti-TB drugs, and alcohol drinking habits were identified predictor of MDR-TB case. Therefore, early detection and proper treatment of drug susceptible TB, strengthening directly observed treatment, short-course on daily bases, community involvement, and supporting the patient to intervene identified factors is paramount.
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Affiliation(s)
- Dabesa Gobena
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Gemechu Ameya
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, P.O. Box: 21, Arba Minch, Ethiopia.
| | - Kinfe Haile
- Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Yoseph Worku
- Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Wang MG, Huang WW, Wang Y, Zhang YX, Zhang MM, Wu SQ, Sandford AJ, He JQ. Association between tobacco smoking and drug-resistant tuberculosis. Infect Drug Resist 2018; 11:873-887. [PMID: 29928135 PMCID: PMC6003534 DOI: 10.2147/idr.s164596] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Tobacco smoking is a risk factor for tuberculosis but little is known about the relationship between tobacco smoking and drug-resistant tuberculosis (DR-TB). We undertook a systematic review and meta-analysis to quantitatively assess the association between DR-TB and tobacco smoking. Methods We searched for relevant studies in the Ovid MEDLINE, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WANFANG, and WEIPU data-bases from inception to September 1, 2017. Results were expressed as odds ratios (ORs) with accompanying 95% CIs, and subgroup analyses were performed by study design, smoking type, DR-TB type, and multivariate analysis. Results Thirty-three studies related to tobacco smoking and DR-TB were included. We found substantial evidence that tobacco smoking is associated with an increased risk of DR-TB (OR 1.57, 95% CI 1.33–1.86). Associations were also found in subgroup analyses: for multidrug-resistant tuberculosis (OR 1.49, 95% CI 1.19–1.86) and for any DR-TB (OR 1.70, 95% CI 1.3–2.23); the pooled OR was 1.45 (95% CI 1.11–1.90) for current smoking, 2.25 (95% CI 1.46–3.47) for past smoking, and 1.56 (95% CI 1.22–1.98) for smoking history; and similar ORs were also observed in study design and multivariate analysis subgroup analysis. Conclusion This study demonstrated that tobacco smoking is an independent risk factor for DR-TB.
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Affiliation(s)
- Ming-Gui Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Wei-Wei Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Yu Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Yun-Xia Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Miao-Miao Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Shou-Quan Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Andrew J Sandford
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
| | - Jian-Qing He
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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Shrestha P, Khanal H, Dahal P, Dongol P. Programmatic Impact of Implementing GeneXpert MTB/ RIF Assay for the Detection of Mycobacterium Tuberculosis in Respiratory Specimens from Pulmonary Tuberculosis Suspected Patients in Resource Limited Laboratory Settings of Eastern Nepal. Open Microbiol J 2018. [PMID: 29541267 PMCID: PMC5842389 DOI: 10.2174/1874285801812010009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background In Nepal, introduction of GeneXpert MTB/RIF assay (Xpert assay) as an initial confirmation test for tuberculosis (TB) has been considered to have impact as a significant decrease in number of clinically diagnosed pulmonary tuberculosis (PTB) cases than previous years. This study aims to find out the distribution profile of suspected tuberculosis cases according to patients age, gender, treatment history and HIV status as well as to evaluate the utility of the Xpert assay over conventional acid-fast bacilli (AFB) staining method for the proper diagnosis of M. Tuberculosis in respiratory specimens from the tuberculosis (TB) suspected patient samples. Methods The prospective cross-sectional analytical study was conducted in National Anti-Tuberculosis Center (NATA) center- Biratnagar and Primary Healthcare Center (PHC) - Manglabare, Morang District, of eastern Nepal from January 2014 to August 2014. Laboratory investigation was done by conventional AFB staining followed by Xpert assay. Results A total of 1549 sputum samples were initially analyzed. AFB staining resulted in 1441 AFB smear negative samples and 88 AFB smear positive samples, whereas 20 samples were directly processed for Xpert assay. The male: female smear positive ratio was 2.8:1 and was higher among age groups (21-40) years. Tuberculosis among HIV patients was found 22.22%. Xpert assay demonstrates that out of 1441 smear negative AFB cases, 258 were found to have TB positive, whereas out of 88 smears positive AFB cases 12 were found to have TB negative. The sensitivity of the Xpert assay in patients classified as AFB smear positive was found 85.4% and the specificity in smear negative patients was 81%. Conclusion The study concluded that implementation of Gene Xpert MTB/RIF assay is a helpful tool for early and rapid detection of tuberculosis with greater sensitivity and specificity over traditional AFB staining techniques.
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Affiliation(s)
- Prakash Shrestha
- Department of microbiology, Sunsari Technical College, Dharan-4, Sunsari, Nepal
| | - Hemanta Khanal
- Central Campus of Technology, Tribhuvan University, Hattisar, Dharan, Sunsari, Nepal
| | - Prasanna Dahal
- Department of Pharmacy, Tribhuvan University, Dharan-4, Sunsari, Nepal
| | - Pranita Dongol
- Department of microbiology, Sunsari Technical College, Dharan-4, Sunsari, Nepal
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Assefa D, Seyoum B, Oljira L. Determinants of multidrug-resistant tuberculosis in Addis Ababa, Ethiopia. Infect Drug Resist 2017; 10:209-213. [PMID: 28744149 PMCID: PMC5513846 DOI: 10.2147/idr.s134369] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Multidrug-resistant tuberculosis (MDR-TB) has been jeopardizing the global effort to prevent and control tuberculosis (TB). However, data on MDR-TB in Ethiopia in general, and in our study area in particular, are very scarce. The aim of this study was to identify determinants of MDR-TB in a cohort of patients managed in two referral hospitals of Addis Ababa, Ethiopia, between April 1, 2013 and June 30, 2013. A health facility-based case-control study was conducted. A total of 710 TB patients (229 confirmed MDR-TB and 481 drug susceptible TB patients) were enrolled in this study. Identified independent determinants for MDR-TB were contact history with a known TB patient (adjusted odds ratio [AOR]: 1.9, 95% CI: 1.1-3.3), previous history of TB treatment (AOR: 11.9, 95% CI: 6.8-21), history of hospitalization (AOR: 4.4 95% CI: 2.2-7.8), sputum-smear positivity (AOR: 1.9, 95% CI: 1.1-3.4), and social stigma (AOR: 5.1, 95% CI: 1.8-14.4). These identified factors should be considered for use in MDR-TB screening tool development if universal drug susceptibility testing is not possible. Moreover, TB infection control practices in health care settings should be further strengthened. As factors may vary from region to region, further broader studies need to be conducted in other parts of Ethiopia.
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Affiliation(s)
| | - Berhanu Seyoum
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Thapa G, Pant ND, Khatiwada S, Lekhak B, Shrestha B. Drug susceptibility patterns of the Mycobacterium tuberculosis isolated from previously treated and new cases of pulmonary tuberculosis at German-Nepal tuberculosis project laboratory, Kathmandu, Nepal. Antimicrob Resist Infect Control 2016; 5:30. [PMID: 27583136 PMCID: PMC5006423 DOI: 10.1186/s13756-016-0129-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/04/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Multidrug resistant tuberculosis (MDR-TB) is a serious public health problem in Nepal. It is a major obstacle for the control of the tuberculosis. The main objectives of this study were to determine the prevalence of the multidrug resistant pulmonary tuberculosis and to evaluate the drug susceptibility patterns of Mycobacterium tuberculosis isolated from previously treated and newly diagnosed cases of pulmonary tuberculosis. METHODS A cross-sectional study was conducted from March 2013 to August 2013 at German-Nepal tuberculosis project (GENETUP) laboratory, Kathmandu, Nepal. For this the sputum samples from total of 153 (49 new and 104 previously treated) suspected pulmonary tuberculosis patients were used. The diagnosis of the tuberculosis was performed by using fluorescent microscopy and culture, while the drug susceptibility testing of Mycobacterium tuberculosis was performed by proportion method. Lowenstein-Jensen (L-J) medium was used for the culture of Mycobacterium tuberculosis and the colonies grown were identified on the basis of the colony morphology, pigment production and biochemical characteristics. RESULTS The prevalence of MDR-TB among all the cases of culture positive pulmonary tuberculosis was 15.6 %. The rate of MDR-TB among previously treated culture positive tuberculosis patients was 19.4 % and that among newly diagnosed culture positive pulmonary tuberculosis cases was 7.1 %. The highest rate of resistance of Mycobacterium tuberculosis, was toward streptomycin (24.4 %) followed by isoniazid (23 %), rifampicin (17.8 %) and ethambutol (15.6 %). Among the total of MDR-TB cases among previously treated patients, highest percentage of the cases were relapse (61.1 %) followed by chronic (16.7 %). CONCLUSIONS The high prevalence of DR/MDR-TB in our study reflects poor implementation of tuberculosis control program. On the basis of the drug susceptibility patterns of M. tuberculosis we found in our study, we recommend to include ethambutol instead of streptomycin in the multidrug therapy for the treatment of tuberculosis patients in Nepal. Further, due to high rate of MDR-TB among previously treated patients, we do not recommend to use first line drugs for the treatment of pulmonary tuberculosis among previously treated patients.
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Affiliation(s)
- Gobinda Thapa
- Department of Microbiology, Goldengate International College, Battisputali, Kathmandu, Nepal
| | - Narayan Dutt Pant
- Department of Microbiology, Grande International Hospital, Dhapasi, Kathmandu, Nepal
| | - Saroj Khatiwada
- Department of biochemistry, Modern Technical College, Lalitpur, Kathmandu, Nepal
| | - Binod Lekhak
- Department of Microbiology, Goldengate International College, Battisputali, Kathmandu, Nepal
| | - Bhawana Shrestha
- German-Nepal Tuberculosis Project (GENETUP), Kalimati, Kathmandu, Nepal
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Misombo-Kalabela A, Nguefack-Tsague G, Kalla GCM, Ze EA, Diangs K, Panda T, Kebela I, Fueza SB, Magazani N, Mbopi-Kéou FX. [Risk factors for multidrug-resistant tuberculosis in the city of Kinshasa in the Democratic Republic of Congo]. Pan Afr Med J 2016; 23:157. [PMID: 27516818 PMCID: PMC4967428 DOI: 10.11604/pamj.2016.23.157.6137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 02/07/2016] [Indexed: 11/11/2022] Open
Abstract
Introduction L'objectif de cette étude était de déterminer les facteurs de risque associés à la tuberculose multi résistance à Kinshasa en République Démocratique du Congo. Méthodes Il s'agissait d'une étude cas témoins. Les cas comprenaient tous les patients tuberculeux résistants à la rifampicine et à l'isoniazide notifiés à Kinshasa de janvier 2012 à juin 2013. Les témoins étaient les patients tuberculeux traités durant la même période que les cas et qui à la fin du traitement étaient déclarés guéris. Pour cette étude, nous avons obtenu une clairance éthique. Résultats L’échantillon était constitué de 213 participants dont 132 hommes (62%) et 81 femmes (38%). L’âge médian était de 31ans (16-73 ans). Les facteurs associés significatifs (p< 0,05) à la tuberculose multi résistante étaient le non-respect des heures de prise de médicaments (0R = 111) (80% chez les cas et 4% chez les témoins), l’échec au traitement (0R = 20) (76% chez les cas et 13% chez les témoins); la notion de tuberculose multi résistante dans la famille (0R = 6.4) (28% chez les cas et 6% chez les témoins); la méconnaissance de la tuberculose multi résistante (0R = 3.2) (31% chez les cas et 59% chez les témoins); un séjour en prison (0R = 7.6) (10% chez les cas et 1% chez les témoins) et l'interruption du traitement (0R = 6.1) ( 59% chez les cas et 19% chez les témoins). Conclusion L’émergence de la tuberculose multi résistante peut être évitée par la mise en place des stratégies de diagnostic et de traitement appropriées.
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Affiliation(s)
| | - Georges Nguefack-Tsague
- Université de Yaoundé I, Faculté de Médecine et des Sciences Biomédicales, Yaoundé, Cameroun
| | | | - Emmanuel Afane Ze
- Université de Yaoundé I, Faculté de Médecine et des Sciences Biomédicales, Yaoundé, Cameroun
| | - Kimpanga Diangs
- Université de Kinshasa, Faculté de Médecine, Département de Santé Publique, République Démocratique du Congo
| | - Tshapenda Panda
- Ministère de la Santé Publique, République Démocratique du Congo
| | - Ilunga Kebela
- Ministère de la Santé Publique, République Démocratique du Congo
| | | | - Nzanzu Magazani
- Ministère de la Santé Publique, République Démocratique du Congo
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Sahebi L, Ansarin K, Mohajeri P, Khalili M, Monfaredan A, Farajnia S, Zadeh SK. Patterns of Drug Resistance Among Tuberculosis Patients in West and Northwestern Iran. Open Respir Med J 2016; 10:29-35. [PMID: 27583054 PMCID: PMC4992749 DOI: 10.2174/1874306401610010029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/15/2016] [Accepted: 03/18/2016] [Indexed: 11/22/2022] Open
Abstract
Background: Tuberculosis (TB) is the leading cause of morbidity and mortality among chronic infectious diseases. Objective: The goal of this cross-sectional study (2011-2013;2013) was to examine the patterns of TB drug resistance among HIV-negative pulmonary TB patients in regions near the Iranian border. Method: To this end, MTB isolates were harvested from 300 HIV-negative, pulmonary smear-positive TB patients from the northwest and west Iranian border provinces. Isolates were subjected to first and second-line drug susceptibility testing by the 1% proportion method. Demographic and clinical data were provided using a questionnaire and information from patient records. Results were analyzed using SPSS-18. Results: The mean age of the patients was 52.03 years and 54.3% were male. The prevalence of resistance to any TB drug was 13.6% (38 cases). Eleven percent of the new treatment TB group (28 patients) and 40.7% of the retreatment TB group (11 patients) were resistant to all TB drugs. Twelve (4.3%) patients had multidrug-resistant tuberculosis (MDR-TB) (2.38% in the new TB treatment group and 23.1% in the retreatment group). One patient had extensively drug-resistant tuberculosis (XDR-TB). There was a statistically significant relationship between TB drug resistance and smoking (p=0.02) and a history of migration from village to city (p=0.04), also between TB drug resistance and recurrence of TB in patients that had previously received treatment (p<0.001). Conclusion: Knowledge of drug resistance patterns for new and previously treated cases is critical for effective control of MDR-TB in different regions of the country. The burden of MDR-TB in retreatment cases was high. Previous TB treatment was one of the most important mokers and those who had a history of rural to urban migration were at high risk for the occurrence of TB drug resistance.
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Affiliation(s)
- Leyla Sahebi
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Science. Tabriz, Iran
| | - Khalil Ansarin
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Science. Tabriz, Iran
| | - Parviz Mohajeri
- Microbiology Department, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Majid Khalili
- Department of Basic Sciences, Maragheh Faculty of Medical Sciences, Maragheh, Iran
| | - Amir Monfaredan
- Department of Hematology, Faculty of Medicine, Tabriz Branch, Islamic Azad University of Tabriz, Iran
| | - Safar Farajnia
- Drug Applied Research Center. Tabriz University of Medical Sciences, Tabriz, Iran
| | - Simin Khayyat Zadeh
- Health Center of East Azerbaijan Province, Tabriz University of Medical Science, Tabriz, Iran
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Status of multidrug resistant tuberculosis (MDR-TB) among the Sahariya tribe of North Central India. J Infect Public Health 2016; 9:289-97. [PMID: 26775848 DOI: 10.1016/j.jiph.2015.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/25/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The incidence/prevalence of tuberculosis (TB) is reported to be high in the Sahariya tribe of North Central India. The outbreaks of different drug-resistant isolates of Mycobacterium tuberculosis emphasized the need for continuous monitoring of resistance to anti-tuberculosis drugs. This study aimed to assess the profile of multidrug resistant TB among the Sahariya tribe and their non-tribal neighbors for first line drugs through field-based investigations. METHODOLOGY A total of 274 sputum positive pulmonary TB individuals were enrolled and studied for their drug susceptibility profile by the proportion method. RESULTS A total of 21 cases from Sahariya and 6 from non-tribes were identified with MDR-TB. Thus Sahariya tribe showed a 1.95-fold increased risk of developing drug resistance than non-tribes. Significant differences were observed for developing drug sensitivity between Sahariya males and females when analyzed for resistance developed to any drug and overall drug resistance vs. sensitive isolates, respectively. A 4.46-fold risk was found for MDR-TB among the smokers of Sahariya tribe, whereas, the non-tribes did not show any significant association. CONCLUSION The drug susceptibility profile developed in the present study indicates that drug-resistant tuberculosis is emerging as a serious public health concern in Sahariya tribe. Urgent and effective control measures and better management policies are needed for the prevention of MDR-TB in the tribe.
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