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Puerto GM, Castro CM, Rubio VV, Fadul S, Montes F. Tuberculosis multirresistente en Colombia, 2013-2018: estudio de casos y controles. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:447-456. [PMID: 38109144 PMCID: PMC10783159 DOI: 10.7705/biomedica.6842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 10/06/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) is difficult to control, has high morbidity and mortality, and demands priority public health intervention. In Colombia, MDR/RR-TB has been becoming more widespread annually. Before the COVID-19 pandemic, over an 8-year period, the number of cases of multidrug-resistant tuberculosis in Colombia was close to a thousand cases. Timely identification of the different risk factors for MDR/RR-TB will contribute fundamentally to the systematic management. OBJECTIVE To determine which risk factors were associated with the presentation of MDR in Colombia between 2013 and 2018. MATERIALS AND METHODS A retrospective case-control study was carried out, for which the data from the routine surveillance of MDR/events in the country were used. RESULTS The cases of multidrug-resistant tuberculosis were mainly in young people, Afrodescendants, and males. Of the clinical conditions, comorbidities such as malnutrition, diabetes, and HIV, presence of at least one factor, such as drug dependence, taking immunosuppressive medications, belonging to the black race, afro, and living in an area of high disease burden were risk factors. CONCLUSION In addition to the diagnosis and timely provision of MDR-TB treatment, it is necessary that public health programs at the local level pay special attention to patients with the identified risk factors.
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Affiliation(s)
- Gloria Mercedes Puerto
- Grupo Micobacterias, RED TB COLOMBIA, Dirección de Investigación en Salud Pública, Instituto Nacional de Salud, Bogotá, D. C., Colombia.
| | - Claudia Marcela Castro
- Equipo Banco de Proyectos, RED TB COLOMBIA, Dirección de Investigación en Salud Pública, Instituto Nacional de Salud, Bogotá, D. C., Colombia.
| | - Vivian Vanesa Rubio
- Grupo Micobacterias, RED TB COLOMBIA, Dirección de Investigación en Salud Pública, Instituto Nacional de Salud, Bogotá, D. C., Colombia.
| | - Santiago Fadul
- Grupo Micobacterias, RED TB COLOMBIA, Dirección de Vigilancia y Análisis del Riesgo en Salud Pública, Instituto Nacional de Salud, Bogotá, D. C., Colombia.
| | - Fernando Montes
- Programa de Tuberculosis, RED TB COLOMBIA, Secretaría de Salud de Medellín, Colombia.
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Olabiyi OE, Okiki PA, Adarabioyo MI, Adebiyi OE, Adegoke OE, Esan OE, Idris OO, Agunbiade TB. Distribution of multi-drug resistant tuberculosis in Ekiti and Ondo states, Nigeria. New Microbes New Infect 2023; 55:101192. [PMID: 38046896 PMCID: PMC10690628 DOI: 10.1016/j.nmni.2023.101192] [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] [Received: 08/29/2022] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Background Tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB), is one of the top infectious killer diseases in the world. The emergence of drug-resistant MTB strains has thrown challenges in controlling TB worldwide. This study investigated the prevalence of drug-resistant tuberculosis in the states of Nigeria and the risk factors that can increase the incidence of tuberculosis. Methods The study is a cross-sectional epidemiological research carried out in the six senatorial districts of Ekiti and Ondo states, Nigeria, between February 2019 and January 2020. A structured questionnaire was administered to 1203 respondents for socio-demographic information, and sputum samples were collected from them for TB investigation. GeneXpert technique was used to diagnose TB from the sputum samples, followed by bacterial isolation using Löweinstein-Jensen medium and antibiotic susceptibility testing. Results Prevalence of TB in the two states combined was 15 %; with 13.8 % for Ekiti state and 16.1 % for Ondo State. The distribution of TB in the senatorial districts was such that: Ondo South > Ekiti Central > Ekiti South > Ondo North > Ekiti North > Ondo Central. The risk factors identified for TB prevalence in two states were gender, male > female (OR = 0.548, p = 0.004); overcrowding (OR = 0.733, p = 0.026); room size (OR = 0.580, p = 0.002); smoking (OR = 0.682, p = 0.019) and dry and dusty season (OR = 0.468, p = 0.005). The prevalence of MDR-TB in Ekiti and Ondo States were 1.2 % and 1.3 % respectively. The identified risk factors for MDR were education (OR = 0.739, p = 0.017), age (OR = 0.846, p = 0.048), religion (OR = 1.95, p = 0.0003), family income (OR = 1.76, p = 0.008), previous TB treatment (OR = 3.64, p = 0.004), smoking (OR = 1.33, p = 0.035) and HIV status (OR = 1.85, p = 0.006). Rifampicin monoresistant was reported in 6.7 % of the rifampicin-resistant strains, while 93.3 % were rifampicin polyresistant strains. Two (13.3 %) of the MDR-TB strains were resistant to all the 3 first-line antimycobacterial agents. All the Rifampicin-resistant TB strains were susceptible to the aminoglycosides (Amikacin, Capreomycin and Kanamycin), also with high susceptibility to the fluoroquinilones: Moxifloxacin (100 %) and Levofloxacin (86.7 %). Sixteen (94.1 %) of the 17 Rifampicin-susceptible strains were susceptible to all the eight antibiotics tested, while one (5.9 %) was susceptible to Rifampicin and Isoniazid but resistant to the rest antibiotics. Conclusion: The study showed that there is high prevalence of TB and MDR-TB in Ekiti and Ondo States Nigeria, hence, to meet the SDG Target 3.3 of ending TB epidemic by 2030, culturing and antibiotic susceptibility testing should be carried out on every TB-positive sputum and the patients treated accordingly.
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Affiliation(s)
- Olugbenga Enoch Olabiyi
- Department of Biological Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
- Department of Medical Microbiology and Parasitology, Ekiti State Teaching Hospital, Ado-Ekiti, Nigeria
| | - Pius Abimbola Okiki
- Department of Biological Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
- Institute of One-Health, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Mumuni Idowu Adarabioyo
- Department of Mathematical & Physical Sciences (Statistics Unit), Afe Babalola University, Ado-Ekiti, Nigeria
| | - Oludele Emmanuel Adebiyi
- South-West Zonal Tuberculosis Reference Laboratory, Department of Medical Microbiology and Parasitology, University College Hospital, Ibadan, Nigeria
| | - Olusola Emannuel Adegoke
- South-West Zonal Tuberculosis Reference Laboratory, Department of Medical Microbiology and Parasitology, University College Hospital, Ibadan, Nigeria
| | - Olubunmi Ebenezer Esan
- Department of Medical Microbiology and Parasitology, Ondo State Specialist Hospital, Akure, Nigeria
| | - Olayinka O. Idris
- Department of Biological Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Toluwani Bosede Agunbiade
- Department of Biological Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
- Department of Integrated General Medical Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
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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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The Targeted Maximum Likelihood estimation to estimate the causal effects of the previous tuberculosis treatment in Multidrug-resistant tuberculosis in Sudan. PLoS One 2023; 18:e0279976. [PMID: 36649340 PMCID: PMC9844833 DOI: 10.1371/journal.pone.0279976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION This study used Targeted Maximum Likelihood Estimation (TMLE) as a double robust method to estimate the causal effect of previous tuberculosis treatment history on the occurrence of multidrug-resistant tuberculosis (MDR-TB). TMLE is a method to estimate the marginal statistical parameters in case-control study design. The aim of this study was to estimate the causal effect of the previous tuberculosis treatment on the occurrence of MDR-TB using TMLE in Sudan. METHOD A case-control study design combined with TMLE was used to estimate parameters. Cases were MDR-TB patients and controls were and patients who cured from tuberculosis. The history of previous TB treatment was considered the main exposure, and MDR-TB as an outcome. A designed questionnaire was used to collect a set of covariates including age, time to reach a health facility, number of times stopping treatment, gender, education level, and contact with MDR-TB cases. TMLE method was used to estimate the causal association of parameters. Statistical analysis was carried out with ltmle package in R-software. Result presented in graph and tables. RESULTS A total number of 430 cases and 860 controls were included in this study. The estimated risk difference of the previous tuberculosis treatment was (0.189, 95% CI; 0.161, 0.218) with SE 0.014, and p-value (<0.001). In addition, the estimated risk ratio was (16.1, 95% CI; 12.932, 20.001) with SE = 0.014 and p-value (<0.001). CONCLUSION Our findings indicated that previous tuberculosis treatment history was determine as a risk factor for MDR-TB in Sudan. Also, TMLE method can be used to estimate the risk difference and the risk ratio in a case-control study design.
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Bacterial infections epidemiology and factors associated with multidrug resistance in the northern region of Ghana. Sci Rep 2022; 12:22069. [PMID: 36543904 PMCID: PMC9772187 DOI: 10.1038/s41598-022-26547-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Bacterial infections caused by multidrug resistant organisms are a major global threat. There is still a knowledge gap on this situation in the Northern Region of Ghana. This study determined the prevalence and resistance profile of bacterial infections. It also identified factors associated with multidrug resistance in the study area. This was a retrospective cross-sectional design and it analyzed data from the samples received at the Tamale Zonal Public Health Reference Laboratory from June 2018 to May 2022. The data were analyzed using the R software version 4.2.0. Univariate and multivariable binary logistic regression analyses were used to determine the factors associated with multidrug resistance. The samples included all specimen types possible. The specimens were collected for the purpose of clinical bacteriology diagnostics. Overall a total of 1222 isolates were obtained. The three (3) main bacteria responsible for infections were: Klebsiella spp. (27%), Moraxella spp. (22%), Escherichia spp. (16%). High resistance levels were found against the tested antibiotics and about 41.60% of the bacterial strains isolated were multidrug resistant. Hospitalization was associated with multidrug resistance in univariate (COR 1.96; 95% CI 1.43-2.71; P-value < 0.001) and multivariable analyses (AOR 1.78; 95% CI 1.28-2.49; P-value < 0.001). There is the need for further research on the molecular epidemiology of antibiotic resistance genes in the study area to effectively control the spread of multidrug resistant pathogens. In addition, efforts to build the capacity of health professionals on infection prevention and control as well as diagnostic and antimicrobial stewardship needs urgent attention.
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Mutayoba BK, Ershova J, Lyamuya E, Hoelscher M, Heinrich N, Kilale AM, Range NS, Ngowi BJ, Ntinginya NE, Mfaume SM, Nkiligi E, Doulla B, Lyimo J, Kisonga R, Kingalu A, Lema Y, Kondo Z, Pletschette M. The second national anti-tuberculosis drug resistance survey in Tanzania, 2017-2018. Trop Med Int Health 2022; 27:891-901. [PMID: 36089572 PMCID: PMC9826299 DOI: 10.1111/tmi.13814] [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] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine the levels and patterns of resistance to first- and second-line anti-tuberculosis (TB) drugs among new and previously treated sputum smear positive pulmonary TB (PTB) patients. METHODS We conducted a nationally representative cross-sectional facility-based survey in June 2017-July 2018 involving 45 clusters selected based on probability proportional to size. The survey aimed to determine the prevalence of anti-TB drug resistance and associated risk factors among smear positive PTB patients in Tanzania. Sputum samples were examined using smear microscopy, Xpert MTB/RIF, culture and drug susceptibility testing (DST). Logistic regression was used to account for missing data and sampling design effects on the estimates and their standard errors. RESULTS We enrolled 1557 TB patients, including 1408 (90.4%) newly diagnosed and 149 (9.6%) previously treated patients. The prevalence of multidrug-resistant TB (MDR-TB) was 0.85% [95% confidence interval (CI): 0.4-1.3] among new cases and 4.6% (95% CI: 1.1-8.2) among previously treated cases. The prevalence of Mycobacterium tuberculosis strains resistant to any of the four first-line anti-TB drugs (isoniazid, rifampicin, streptomycin and ethambutol) was 1.7% among new TB patients and 6.5% among those previously treated. Drug resistance to all first-line drugs was similar (0.1%) in new and previously treated patients. None of the isolates displayed poly-resistance or extensively drug-resistant TB (XDR-TB). The only risk factor for MDR-TB was history of previous TB treatment (odds ratio = 5.7, 95% CI: 1.9-17.2). CONCLUSION The burden of MDR-TB in the country was relatively low with no evidence of XDR-TB. Given the overall small number of MDR-TB cases in this survey, it will be beneficial focusing efforts on intensified case detection including universal DST.
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Affiliation(s)
- Beatrice Kemilembe Mutayoba
- Department of Preventive ServicesMinistry of Health National AIDS Control ProgramDodomaTanzania,Department of Infectious Diseases and Tropical MedicineMedical Center of the University of MunichMunichGermany
| | - Julia Ershova
- Division of Global HIV and TB, Global TB BranchUS Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Eligius Lyamuya
- Department of Microbiology and ImmunologyMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Michael Hoelscher
- Department of Infectious Diseases and Tropical MedicineMedical Center of the University of MunichMunichGermany
| | - Norbert Heinrich
- Department of Infectious Diseases and Tropical MedicineMedical Center of the University of MunichMunichGermany
| | - Andrew Martin Kilale
- Muhimbili Medical Research CentreNational Institute for Medical ResearchDar es SalaamTanzania
| | - Nyagosya Segere Range
- Muhimbili Medical Research CentreNational Institute for Medical ResearchDar es SalaamTanzania
| | - Benard James Ngowi
- Mbeya College of Health and Allied SciencesUniversity of Dar es SalaamMbeyaTanzania
| | | | - Saidi Mwinjuma Mfaume
- Muhimbili Medical Research CentreNational Institute for Medical ResearchDar es SalaamTanzania
| | - Emmanuel Nkiligi
- National Tuberculosis and Leprosy Program, Department of Preventive ServicesMinistry of HealthDodomaTanzania
| | - Basra Doulla
- National Tuberculosis and Leprosy ProgramCentral Tuberculosis Reference LaboratoryDar es SalaamTanzania
| | - Johnson Lyimo
- National Tuberculosis and Leprosy Program, Department of Preventive ServicesMinistry of HealthDodomaTanzania
| | - Riziki Kisonga
- Kibong'oto Infectious Diseases HospitalKilimanjaroTanzania
| | - Amri Kingalu
- National Tuberculosis and Leprosy Program, Department of Preventive ServicesMinistry of HealthDodomaTanzania
| | - Yakobo Lema
- Muhimbili Medical Research CentreNational Institute for Medical ResearchDar es SalaamTanzania
| | - Zuwena Kondo
- National Tuberculosis and Leprosy Program, Department of Preventive ServicesMinistry of HealthDodomaTanzania
| | - Michel Pletschette
- Department of Infectious Diseases and Tropical MedicineMedical Center of the University of MunichMunichGermany
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Cheng N, Wu S, Luo X, Xu C, Lou Q, Zhu J, You L, Li B. A Comparative Study of Chest Computed Tomography Findings: 1030 Cases of Drug-Sensitive Tuberculosis versus 516 Cases of Drug-Resistant Tuberculosis. Infect Drug Resist 2021; 14:1115-1128. [PMID: 33776457 PMCID: PMC7987723 DOI: 10.2147/idr.s300754] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/04/2021] [Indexed: 01/15/2023] Open
Abstract
Purpose To investigate the CT features of drug-resistant pulmonary tuberculosis (DR-PTB) and the diagnostic value of CT in DR-PTB diagnosis to provide imaging evidence for the timely detection of drug-resistant Mycobacterium tuberculosis. Materials and Methods A total of 1546 cases of pulmonary tuberculosis (PTB) with complete clinical data, chest CT images and defined drug sensitivity testing results were consecutively enrolled; 516 cases of DR-PTB were included in the drug-resistant group, and 1030 cases of drug-sensitive pulmonary tuberculosis (DS-PTB) were included in the drug-sensitivity group. Comparative analyses of clinical symptoms and imaging findings were conducted. Univariate and logistic regression analyses were performed, a regression equation model was developed, and the receiver operating characteristic (ROC) curve was constructed. Results In the univariate analysis, some features, including whole-lung involvement, multiple cavities, thick-walled cavities, collapsed lung, disseminated lesions along the bronchi, bronchiectasis, emphysema, atelectasis, calcification, proliferative lesions, encapsulated effusion, etc., were observed more frequently in the DR-PTB group than in the DS-PTB group, and the differences were statistically significant (p<0.05). Exudative lesions and pneumoconiosis were observed more frequently in the drug-sensitivity group than in the drug-resistant group (p<0.05). Logistic regression analysis indicated that whole-lung involvement, multiple cavities, thick-walled cavities, disseminated lesions along the bronchi, bronchiectasis, and emphysema were independent risk factors for DR-PTB, and exudative diseases were protective factors. The total prediction accuracy of the regression model was 80.6%, and the area under the ROC curve (AUC) was 82.6%. Conclusion Chest CT manifestations of DR-PTB had certain characteristics that significantly indicated the possibility of drug resistance in tuberculosis patients, specifically when multifarious imaging findings, including multiple cavities, thick-walled cavities, disseminated lesions along the bronchi, whole-lung involvement, etc., coexisted simultaneously. These results may provide imaging evidence for timely drug resistance detection in suspected drug-resistant cases and contribute to the early diagnosis of DR-PTB.
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Affiliation(s)
- Nianlan Cheng
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, People's Republic of China
| | - Shuo Wu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, People's Republic of China
| | - Xianli Luo
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, People's Republic of China
| | - Chunyan Xu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, People's Republic of China
| | - Qin Lou
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, People's Republic of China
| | - Jin Zhu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, People's Republic of China
| | - Lu You
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, People's Republic of China
| | - Bangguo Li
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, People's Republic of China
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Sultana ZZ, Hoque FU, Beyene J, Akhlak-Ul-Islam M, Khan MHR, Ahmed S, Hawlader DH, Hossain A. HIV infection and multidrug resistant tuberculosis: a systematic review and meta-analysis. BMC Infect Dis 2021; 21:51. [PMID: 33430786 PMCID: PMC7802168 DOI: 10.1186/s12879-020-05749-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/27/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) in HIV infected individuals is a serious threat to global efforts to combat tuberculosis. Inconsistent findings on the association between HIV infection and MDR-TB were present in many studies. We aimed to review existing data on the relationship between HIV infection and MDR-TB systematically to assess the contribution of HIV on MDR-TB worldwide. We also investigated the patterns of MDR-TB by age, country-wise income, study designs, and global regions. METHODS We utilized PubMed, Google Scholar, and ScienceDirect databases to select eligible studies for meta-analysis that were published between January 12,010, and July 30, 2020. The random-effects model was used to obtain the pooled odds ratio of the crude association between HIV and MDR-TB with a 95% confidence interval. We investigated the potential publication-bias by checking funnel plot asymmetry and using the Egger's test. Moreover, we assessed the heterogeneity using the I2 statistic. Sensitivity analysis was performed based on sample size and adjustment factors. The protocol was registered with PROSPERO-CRD42019132752. RESULTS We identified 1603 studies through a database search, and after subsequent eliminations we selected 54 studies including 430,534 TB patients. The pooled odds of MDR-TB was 1.42 times higher in HIV-positive patients than HIV-negative patients (OR=1.42,CI=1.17-1.71, I2=75.8%). Subgroup analysis revealed that the estimated pooled odds for South-East Asian countries was 1.86, which is the highest in WHO regions (OR=1.86,CI=1.30-2.67, I2=0.00%), followed by Europe and Africa. The effect estimate was found to be higher for primary MDR-TB (OR=2.76,CI=1.70-4.46, I2=0.00%). There was also a trend towards increased odds of MDR-TB for HIV patients older than 40 years (OR=1.56,CI=1.17-2.06). The association was found to be significant in high-burden TB countries (OR=1.75, CI=1.39-2.19) and in high-income countries (OR=1.55, CI=1.06-2.27). CONCLUSION Such findings indicate that HIV infection raises the risk of MDR-TB, and after contrasting it with the results of the earlier pooled study, it appeared to be an upward risk trend. Moreover, we found that the risk is the highest in the South-East Asian region. A balanced allocation of resources is needed to halt both primary and secondary MDR-TB, particularly in HIV infected people with 40 years of age and older.
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Affiliation(s)
- Zeeba Zahra Sultana
- CAPABLE- A Cambridge-led program in Bangladesh, University of Cambridge, Cambridge, UK
| | - Farhana Ul Hoque
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Md Akhlak-Ul-Islam
- Department of Hematology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Shakil Ahmed
- Global Health Institute, North South University, Dhaka, Bangladesh
| | | | - Ahmed Hossain
- Department of Public Health, North South University, Dhaka, Bangladesh. .,Global Health Institute, North South University, Dhaka, Bangladesh. .,Health Management BD Foundation, Dhaka, Bangladesh.
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Biru D, Woldesemayat EM. Determinants of Drug-Resistant Tuberculosis in Southern Ethiopia: A Case-Control Study. Infect Drug Resist 2020; 13:1823-1829. [PMID: 32606831 PMCID: PMC7305943 DOI: 10.2147/idr.s256536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/01/2020] [Indexed: 01/12/2023] Open
Abstract
Background In most developing countries, including in Ethiopia, the magnitude and risk factors of drug-resistant tuberculosis (DR-TB) are expected to be high. However, this is not well reported because of lack of laboratory facilities, poor surveillance system and limited reporting. The aim of this study was to determine the risk factors of DR-TB among TB patients in southern Ethiopia. Patients and Methods Facility-based case–control study was conducted from November 2016 to January 2017 in Sidama Zone and Gurage Zone of the southern Ethiopia region. DR-TB cases were confirmed by drug-susceptibility testing who were on treatment for DR-TB at Yirgalem and Butajira Hospitals. Controls were smear-positive pulmonary tuberculosis (TB) patients who were taking first-line anti-TB medications and sputum smear-negative at the 5th month of commencing TB treatment. Data were entered and cleaned using EPI-Info version 7 software and analyzed using SPSS version 22 statistical software. Results A total of 84 cases and 243 controls participated in the study. About 59% (49 cases) and 55% (132 controls) were male. The median (interquartile range) age was 28 (21–37) years for cases and 27 (25–33) years for controls. Living in a one-roomed house (adjusted odds ratio [AOR]: 6.8, 95% CI: 1.8–25.8), history of contact with DR-TB cases (AOR: 6.8, 95% CI: 1.8–25.3), treatment failure TB cases (AOR: 4.2, 95% CI: 1.1–15.5) and relapsed TB cases (AOR: 4.8, 95% CI: 1.3–18.1) were independent factors associated with DR-TB. Conclusion Providing standardized first-line regimen for new case and retreatment TB cases and practicing basic TB-infection control measures could help to minimize the spread of DR-TB.
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Gebretsadik D, Ahmed N, Kebede E, Mohammed M, Belete MA. Prevalence of Tuberculosis by Automated GeneXpert Rifampicin Assay and Associated Risk Factors Among Presumptive Pulmonary Tuberculosis Patients at Ataye District Hospital, North East Ethiopia. Infect Drug Resist 2020; 13:1507-1516. [PMID: 32547120 PMCID: PMC7247715 DOI: 10.2147/idr.s248059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/29/2020] [Indexed: 01/05/2023] Open
Abstract
Background Tuberculosis is a communicable disease that is a major cause of ill health, one of the top 10 causes of death worldwide, and the leading cause of death from a single infectious agent, even ranking above human immuno-deficiency virus (HIV/AIDS). Objective To assess the prevalence and associated risk factor of Mycobacterium tuberculosis among pulmonary tuberculosis (PTB) suspects attending at Ataye District Hospital from October 1, 2018, to February 30, 2019. Methodology A facility-based cross-sectional study was conducted among 423 presumptive tuberculosis patients at Ataye District Hospital. Sputum was processed by MTB/RIF Xpert assay. Data were entered into EpiData 3.1 software and exported to SPSS version 20.0 (SPSS, Chicago, IL, USA) for analysis. Univariate and multivariate analyses were used to examine the relationship between the dependent and independent variables. Variables that show significance at P-value of 0.3 during univariate analysis were selected for multivariable analysis. A P-value of less than or equal to 0.05 was used to indicate statistical significance. Results Out of the total study participants, about 60% were male, and 39% were aged between 18 and 24 years. Of the total 423 PTB suspected patients, 38 (8.98%) of them were identified as having PTB by GeneXpert and 2/38 (5.3%) were resistant to rifampicin and 3/38 (7.89%) patients were co-infected with HIV. Participant age between 18 and 24 years and between 25 and 34 years, weight loss, chest pain, having contact history with confirmed PTB cases, utilization of congested transportation, and a history of imprisonment were significantly associated with the prevalence of PTB. Conclusion A considerable prevalence of PTB in the area was observed and the magnitude of MDR-TB was low. PTB is still a public health problem in Ethiopia and there is a need for collaborative prevention and control activities in the study area.
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Affiliation(s)
- Daniel Gebretsadik
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Nuru Ahmed
- Ataye District Hospital, Ataye, Ethiopia
| | - Edosa Kebede
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Miftah Mohammed
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Melaku Ashagrie Belete
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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