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Alehegn E, Gebreyohanns A, Berhane BW, Wright JA, Hundie GB, Geremew RA, Gorems K, Gebreyohannes Z, Amare M, Abebaw Y, Diriba G, Zerihun B, Gebremichael AW, Kassa M, Gize A. Phenotypic Drug Resistance Pattern and Mutation Characteristics of Mycobacterium tuberculosis from Different Body Fluids Among Extra Pulmonary Patients Presented in Selected Hospitals in Addis Ababa, Ethiopia. Infect Drug Resist 2023; 16:5511-5522. [PMID: 37638071 PMCID: PMC10460178 DOI: 10.2147/idr.s415906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023] Open
Abstract
Background Drug resistance in tuberculosis poses challenges to both the control and prevention of the disease. The extent of resistance is not well known in developing countries, including Ethiopia. This study was conducted to determine the drug resistance patterns and mutation characteristics of Mycobacterium tuberculosis among extra pulmonary tuberculosis patients in selected health facilities in Addis Ababa. Material and Methods A cross-sectional study was conducted from February 2022 to August 2022 in selected hospitals in Addis Ababa. Socio-demographic and clinical data were collected using structured questionnaire. Mycobacterium tuberculosis complex (MTBC) isolates were tested for phenotypic drug susceptibility patterns using the Mycobacterium growth indicator tube (MGIT) method for first-line drugs and mutation characteristics using the Line Probe Assay (LPA) method. The data were analyzed using: SPSS version 23, and a P-value ≤ 0.05 was considered statistically significant. Results From a total of 308 patient samples from presumptive extra pulmonary patients, 44 (14.3%) were positive for MTBC. Any drug resistance was discovered in 25% of 44 MTBC isolates evaluated for five first-line drugs phenotypically, with isoniazid (INH) and pyrazinamide (PZA) resistance accounting for a greater proportion with 13.6% and 11.4% of the isolates, respectively. Two (4.5%) of the isolates were MDR-TB. Out of 44 isolates tested using the Geno Type MTBDRplus assay, 5 (11.4%) showed mutations at katG and 2 (4.5%) showed mutations in the rpoB genes. Conclusion Both the phenotypic and genotypic drug susceptibility test results showed a high proportion of INH resistance. All INH resistance-conferring mutations were identified from katG gene. The overall prevalence of MDR-TB was also high. For early case detection and treatment, expanding diagnostic capacity for first-line DST is a vital step to limit further spread of drug resistant TB strains in the study area.
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Affiliation(s)
- Elias Alehegn
- Department of Microbiology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Addis Ababa City Administration, Farmers and Urban Agriculture Development Commission, Addis Ababa, Ethiopia
| | - Alganesh Gebreyohanns
- Department of Microbiology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Bereket Woldeab Berhane
- Department of Pathology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Gadissa Bedada Hundie
- Department of Microbiology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Rozina Ambachew Geremew
- Department of Microbiology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Kasahun Gorems
- Department of Microbiology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Zenebe Gebreyohannes
- Department of Microbiology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Misikir Amare
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Getu Diriba
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | - Melkayehu Kassa
- Department of Microbiology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Addisu Gize
- Department of Microbiology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- CIH Center for International Health, LMU University Hospital, Munich, Germany
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Alehegn E, Gebreyohanns A, Berhane B, Wright J, Fantahun M, Hailu M, Buta B, Kassa M, Woldu T, Dejene N, Zena N, Tesfaye T, Gezahegn A, Getinet T, Gize A. Burden of Mycobacterium tuberculosis and Associated Factors among Presumptive Extra pulmonary Tuberculosis Patients from Selected Health Facilities, Addis Ababa, Ethiopia. IJID Reg 2023; 7:199-205. [PMID: 37114203 PMCID: PMC10127111 DOI: 10.1016/j.ijregi.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/02/2023] [Accepted: 03/11/2023] [Indexed: 04/29/2023]
Abstract
Background Extra pulmonary tuberculosis (EPTB) accounts for a significant proportion of tuberculosis (TB), a devastating disease of public health concern. The complexity of the cases, the involvement of many organs, resource constraints, and concerns regarding drug resistance make disease diagnosis and treatment difficult. This study aimed to determine the burden of tuberculosis and associated factors among presumptive EPTB patients in selected hospitals in Addis Ababa. Material and methods A cross-sectional study was conducted from February to August 2022 in selected public hospitals in Addis Ababa. Those who attended the hospitals and were presumptively diagnosed as EPTB patient were included in the study. Sociodemographic and clinical data were collected using a semistructured questionnaire. The GeneXpert MTB/RIF assay, Mycobacterium Growth Indicator Tube (MGIT) culture, and solid culture using Löwenstein-Jensen (LJ) medium were used. The data were entered and analyzed using SPSS version 23, and a p-value ≤ 0.05 was considered as statistically significant. Results From a total of 308 participants enrolled in this study, the measured burdens of extrapulmonary tuberculosis using the Xpert MTB/RIF assay, liquid culture, and solid culture were 54 (17.5%), 45 (14.6%), and 39 (12.7%), respectively. In this study, sex, contact history with known TB cases, having a purulent type of aspirate, and being HIV positive had statistically significant associations with EPTB. Conclusions The burden of extrapulmonary tuberculosis among presumptive extrapulmonary tuberculosis cases was found to be significant. Sex, contact history with a known TB case, having apurulent type of aspirate, and being HIV positive were found to be associated with extrapulmonary tuberculosis infection. Strict adherence to the national tuberculosis diagnosis and treatment guidelines is important, while the true burden of the disease should be ascertained using standard diagnostic tests for better prevention and control interventions.
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Affiliation(s)
- Elias Alehegn
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Addis Ababa City Administration, Farmers and Urban Agriculture Development Commission, Addis Ababa, Ethiopia
| | | | - Bereket Berhane
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Mengistu Fantahun
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Michael Hailu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Bedo Buta
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Melkayehu Kassa
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tsedale Woldu
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Natnael Dejene
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Nuhamen Zena
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Azeb Gezahegn
- Ras Desta Damtew Memorial Hospital, Addis Ababa, Ethiopia
| | - Tilahun Getinet
- Addis Ababa City Administration, Farmers and Urban Agriculture Development Commission, Addis Ababa, Ethiopia
| | - Addisu Gize
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- CIH Center for International Health, University Hospital, LMU Munich, Germany
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Lohiya S, Tripathy JP, Sagili K, Khanna V, Kumar R, Ojha A, Bhatnagar A, Khanna A. Does Drug-Resistant Extrapulmonary Tuberculosis Hinder TB Elimination Plans? A Case from Delhi, India. Trop Med Infect Dis 2020; 5:E109. [PMID: 32630163 DOI: 10.3390/tropicalmed5030109] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/05/2022] Open
Abstract
Extrapulmonary drug-resistant tuberculosis (DR-EPTB) poses a formidable diagnostic and therapeutic challenge.Besides associated with high morbidity, it is a major financial burden for the patient and the health system. In spite of this, it has often been neglected as it does not “pose” a visible public health threat. We study clinical profiles, treatment outcomes, and factors associated with unfavourable outcomes among DR-EPTB patients under programmatic settings in New Delhi, India, and evaluate how this could impact TB elimination. A retrospective analysis of all DR-EPTB patients registered at three nodal DR-TB centres in Delhi in 2016 was carried out. Of the 1261 DR-TB patients registered, 203 (16%) were DR-EPTB, with lymph nodes (118, 58%) being the most common site, followed by bone (69, 34%). Nearly 29% (n = 58) experienced adverse drug reactions with severe vomiting (26, 13 %), joint pain (21, 10%) and behavioral disorder (15, 7%). History of previous TB treatment was observed in a majority of the cases (87.7%). Nearly one-third of DR-EPTB cases (33%) had unfavourable treatment outcomes, with loss-to-follow-up (n = 40, 58%) or death (n = 14, 20%) being the most common unfavourable outcomes. In the adjusted analysis, weight band 31–50 kilograms (aRR = 1.8, 1.2–3.4) and h/o previous TB (aRR = 2.1, 1.1–4.8) were mainly associated with unfavourable outcomes. TB elimination efforts need to focus on all forms of TB, including DR-EPTB, leaving no one behind, in order to realise the dream of ending TB.
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Boonsarngsuk V, Mangkang K, Santanirand P. Prevalence and risk factors of drug-resistant extrapulmonary tuberculosis. Clin Respir J 2018; 12:2101-2109. [PMID: 29424965 DOI: 10.1111/crj.12779] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/04/2017] [Accepted: 02/04/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Physicians are usually aware of the occurrence of drug-resistant (DR) pulmonary tuberculosis (PTB), but lack concern about DR-extrapulmonary TB (EPTB). Data regarding the prevalence and risk factors of DR-EPTB remain limited. OBJECTIVES To determine the prevalence and risk factors of DR-EPTB. METHODS A retrospective study was performed in patients who had culture-proven Mycobacterium tuberculosis (MTB) from various specimens between January 2013 and December 2015. Patients were classified into three groups: PTB, EPTB and concomitant PTB and EPTB (PTB + EPTB). Clinical data, chest radiographic extent of disease and patterns of DR were collected. RESULTS There were 1014 culture-proven MTB specimens (716 pulmonary specimens and 298 extrapulmonary specimens) from 986 patients (648 PTB, 218 EPTB and 120 PTB + EPTB). The prevalences of isoniazid-, rifampicin- and multidrug-resistant EPTB were 7.8%, .5% and .5%, respectively, which were lower than those of PTB. When PTB and EPTB coexisted, a higher rate of DR-TB was observed than for PTB alone. Of 338 EPTB patients, the extent of radiographic disease was associated with isoniazid-, rifampicin- and multidrug-resistant TB. Previous history of TB and use of steroids/immunosuppressive drugs were also associated with rifampicin- and multidrug-resistant TB in multivariate analysis. CONCLUSIONS The prevalence of DR-EPTB was high in patients who had concomitant PTB. Although the prevalences of rifampicin- and multidrug-resistant TB were low in isolated EPTB, the prevalence of isoniazid-resistant TB remained high. Therefore, drug susceptibility testing should be performed in EPTB patients, especially those who carry the aforementioned risk factors.
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Affiliation(s)
- Viboon Boonsarngsuk
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Khattiya Mangkang
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Pitak Santanirand
- Microbiology Laboratory, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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