Apo Lipoproteins A1 and B in Multidrug-Resistant Tuberculosis (MDR-TB)

Aims: The medical management of multidrug-resistant tuberculosis (MDR-TB) has become a major public health issue. Apolipoproteins play a key role in lipoprotein metabolism such as the recognition of receptors involved in lipoprotein metabolism. Thus, the study of the inter- relationships between apolipoproteins (A1 and B) and MDR-TB could represent an important approach to the biological management of MDR-TB patients.Methodology: This is an experimental study carried out on eighty-two (82) patients including thirty-eight (38) MDR-TB patients which age ranged from 18 to 60 years old recruited from three tuberculosis centers (CAT) in the city of Abidjan and forty-four (44) non-tuberculosis patients used as control aged 18 to 60 years old recruited at the National Blood Transfusion Center (CNTS) in Treichville (Abidjan, C魌e d扞voire). Total cholesterol, HDL-cholesterol and triglycerides were measured by the colorimetric-enzymatic method. Apolipoproteins A1 and B were measured using the immunoturbidimetric method.Results and Conclusion: Showed a dyslipidemia concerning cholesterol and its HDL fraction, triglycerides and apolipoproteins A1 and B suggest an atherogenic profile in multidrug-resistant TB patients.

Bedaquilina en el tratamiento de tuberculosis multirresistente en pediatría / Bedaquiline in the treatment of multidrug-resistant tuberculosis in pediatrics

RESUMEN La tuberculosis multirresistente surge de cepas de Mycobacterium tuberculosis con resistencia in vitro al menos a isoniacida y rifampicina, dos drogas de primera línea claves para el tratamiento. Anualmente, alrededor de treinta mil niños en el mundo contraen esta forma de tuberculosis, y menos del 5 % recibe tratamiento adecuado. El enfoque para estos casos debe seguir el perfil de sensibilidad del germen y tratar de lograr la curación del paciente con el menor número de complicaciones y secuelas po sibles, y prevenir la transmisión comunitaria de la enfermedad. En 2022 la Organización Mundial de la Salud recomendó la bedaquilina para el tratamiento de la tuberculosis multirresistente en adultos y niños de todas las edades. Nuestro objetivo es comunicar nuestra experiencia sobre la administración de bedaquilina en niños y adolescentes en el contexto del tratamiento de la tuberculosis multirresistente de acuerdo con las últimas recomendaciones.

ABSTRACT Multidrug-resistant tuberculosis arises from strains of Mycobacterium tuberculosis with in vitro resistance to at least isoniazid and rifampicin, two key first-line drugs for treatment. Annually, around 30 000 children worldwide contract this form of tuberculosis, and less than 5 % receive adequate treatment. The approach for these cases should follow the sensitivity profile of the germ, trying to achieve the patient's cure with the fewest pos sible complications and sequelae, and prevent community transmission of the disease. In 2022, the World Health Organization recommended bedaquiline for the treatment of multidrug-resistant tuberculosis in adults and children of all ages. Our objective is to communicate our experience on the administration of bedaquiline in children and adolescents in the context of multidrug-resistant tuberculosis treatment in accordance with the latest recommendations.

Evaluation of Mycobacterium tuberculosis by conventional methods, GeneXpert and line probe assay in cases of extrapulmonary tuberculosis

Background: Diagnosis of EPTB is often delayed due to its paucibacillary nature. Diagnostic modalities like conventional methods and molecular methods like GeneXpert are employed for Mycobacteria detection and their results are compared. Line Probe Assay is used for determination of resistance in first line and in second line anti-tubercular drugs. Methods: In this study 302 extrapulmonary samples from suspected cases of all age groups were included. Samples were first homogenised and decontaminated and then subjected to various diagnostic modalities like microscopy, culture and GeneXpert for Mycobacteria detection. Culture and smear positive isolates were subjected to LPA for determination of drug resistance in first and second-line anti-tubercular drugs. Results: Out of the 302 extrapulmonary samples, maximum samples were of lymph nodes (19.86%) followed by pus (17.88%). Male to female ratio was 1:3. GeneXpert detected 45.04% positive cases and 5.96% were rifampicin resistant. Positive samples detected by microscopy and culture were 21.19% and 24.17% respectively. When compared to culture, microscopy showed a sensitivity of 86.30% and specificity of 99.56%. GeneXpert reported 100% sensitivity and 72.48% specificity. LPA reported 9.45% isoniazid resistant cases, 4.05% rifampicin resistant cases and 5.40% both isoniazid and rifampicin resistant cases (MDR-TB). Out of the MDR-TB cases, 25% cases were resistant to fluoroquinolones indicating pre-XDR TB. Conclusions: For Mycobacterium tuberculosis detection in extrapulmonary samples, multiple modalities should be employed so that the bacilli in these samples is not missed and the turn-around time is lowered which is a key to TB control strategy.

Evaluation of Mycobacterium tuberculosis by conventional methods, GeneXpert and line probe assay in cases of extrapulmonary tuberculosis

Background: Diagnosis of EPTB is often delayed due to its paucibacillary nature. Diagnostic modalities like conventional methods and molecular methods like GeneXpert are employed for Mycobacteria detection and their results are compared. Line Probe Assay is used for determination of resistance in first line and in second line anti-tubercular drugs. Methods: In this study 302 extrapulmonary samples from suspected cases of all age groups were included. Samples were first homogenised and decontaminated and then subjected to various diagnostic modalities like microscopy, culture and GeneXpert for Mycobacteria detection. Culture and smear positive isolates were subjected to LPA for determination of drug resistance in first and second-line anti-tubercular drugs. Results: Out of the 302 extrapulmonary samples, maximum samples were of lymph nodes (19.86%) followed by pus (17.88%). Male to female ratio was 1:3. GeneXpert detected 45.04% positive cases and 5.96% were rifampicin resistant. Positive samples detected by microscopy and culture were 21.19% and 24.17% respectively. When compared to culture, microscopy showed a sensitivity of 86.30% and specificity of 99.56%. GeneXpert reported 100% sensitivity and 72.48% specificity. LPA reported 9.45% isoniazid resistant cases, 4.05% rifampicin resistant cases and 5.40% both isoniazid and rifampicin resistant cases (MDR-TB). Out of the MDR-TB cases, 25% cases were resistant to fluoroquinolones indicating pre-XDR TB. Conclusions: For Mycobacterium tuberculosis detection in extrapulmonary samples, multiple modalities should be employed so that the bacilli in these samples is not missed and the turn-around time is lowered which is a key to TB control strategy.

Disease burden of multidrug-resistant tuberculosis in China and regions with different income levels in the world / 公共卫生与预防医学

Objective To analyze the disease burden of multidrug-resistant tuberculosis (MDR-TB) in China and regions with different income levels in the world from 1990 to 2019. Methods Using the Global Burden of Disease Study 2019 (GBD2019) results, the changes of the disease burden of MDR-TB in China and regions with different income levels in the world were described and analyzed using the Joinpoint Regression Program 4.8.0.1 software. Results From 1990 to 2019, the age standardized incidence, mortality and DALY rates in China and other areas with different income levels in the world basically showed a trend of first rising and then decreasing at the turning point of the late 20th century and early 21st century, except for low-income areas where the age standardized incidence rate showed an overall upward trend. In 2019, the incidence rate, mortality and DALY rate of MDR-TB in China were 9 times, 6.67 times and 6.89 times higher than those in high-income areas, respectively. The incidence rate in China was 6 times lower than that in low and middle-income areas, while the mortality and DALY rate in China were 26 times and 32.53 times lower than those in low-income areas, respectively. The age standardized incidence, mortality rate and DALY rate of MDR-TB in men were higher than those in women. Risk factors for the burden of MDR-TB disease included alcohol consumption, smoking, and high fasting blood glucose. Conclusion From 1990 to 2019, there are significant regional and gender differences in the disease burden of multidrug-resistant tuberculosis in China and regions with different income levels in the world. Multidrug-resistant tuberculosis is still a major challenge for tuberculosis control in the world. It is necessary to develop more effective control strategies and health care systems to deal with multidrug-resistant tuberculosis.

Review on Drug Resistant Tuberculosis

Introduction: An estimated 9.9 million people fell ill with tuberculosis globally in 2020 with India and China contribu?ng a major percentage to the burden of TB. India is grouped under high TB, high HIV associated TB and MDR TB burden countries and 1.24 lakh fell ill with drug resistant TB out of which 56000 were started on second line treatment in 2020. Annually India accounts for 27% of missing TB cases. Diagnosis: The major forms of drug resistant TB that are of clinical importance are INH monoresistant TB, mul?drug resistant TB, pre- XDR TB and XDR TB.WHO approved newer molecular tests for MTB detec?on and drug suscep?bility tests. Treatment: Few newer drugs and few previously used drugs are showing promise when used in combina?on which have come up in recent years. Bedaquiline based regimens are showing improved cure rates. Conclusion: Guidelines based regimens should be strictly adhered to by both public and private TB case trea?ng physicians.

Practical Pharmacological Aspects of Drugs Used for the Treatment of Drug-Resistant Tuberculosis in Adults and Children / Aspectos farmacológicos prácticos de las drogas para el tratamiento de la tuberculosis drogorresistente en adultos y pediatría

ABSTRACT The emergence of resistant strains of Mycobacterium tuberculosis to multiple drugs and the difficulties of their diagnosis and treatment constitute a challenge to global public health. To face this challenge, new anti-tuberculosis drugs, such as bedaquiline, pretomanid, and delamanid, as well as replacement drugs, such as fluoroquinolones, linezolid and clofazimine, are used. Based on the evidence provided by multicenter studies, drugs associated with a better prognosis of drug-resistant tuberculosis have been discovered and, recently, a new classification has been proposed, as well as new totally oral regimens. In this review, we describe current treatment regimens and practical pharmacological aspects required when prescribing new drug-resistant tuberculosis treatment regimens.

RESUMEN La emergencia de cepas resistentes de Mycobacterium tuberculosis a múltiples drogas, las dificultades de su diagnóstico y tratamiento constituyen un desafío a la salud pública mundial. Para afrontar esta situación, se emplean nuevas drogas antituberculosis, como bedaquilina, pretomanid y delamanid, así como drogas repropuestas, como fluoroquinolonas, linezolid y clofazimina. Con base en la evidencia brindada por estudios multicéntricos, se han descubierto fármacos asociados a un mejor pronóstico de la tuberculosis drogorresistente y, recientemente, se ha propuesto una nueva clasificación, así como nuevos esquemas totalmente orales. En esta revisión, describimos los esquemas de tratamiento actuales y los aspectos farmacológicos prácticos necesarios a la hora de la prescripción de los nuevos regímenes de tratamiento de la tuberculosis drogorresistente.

Aspectos farmacológicos prácticos de las drogas para el tratamiento de la tuberculosis drogorresistente en adultos y pediatría / Practical Pharmacological Aspects of Drugs Used for the Treatment of Drug-Resistant Tuberculosis in Adults and Children

La emergencia de cepas resistentes de Mycobacterium tuberculosis a múltiples drogas, las dificultades de su diagnóstico y tratamiento constituyen un desafío a la salud pública mundial. Para afrontar esta situación, se emplean nuevas drogas antituberculosis, como bedaquilina, pretomanid y delamanid, así como drogas repropuestas, como fluoroquinolonas, linezolid y clofazimina. Con base en la evidencia brindada por estudios multicéntricos, se han descubierto fármacos asociados a un mejor pronóstico de la tuberculosis drogorresistente y, recientemente, se ha propuesto una nueva clasificación, así como nuevos esquemas totalmente orales. En esta revisión, describimos los esquemas de tratamiento actuales y los aspectos farmacológicos prácticos necesarios a la hora de la prescripción de los nuevos regímenes de tratamiento de la tuberculosis drogorresistente.

The emergence of resistant strains of Mycobacterium tuberculosis to multiple drugs and the difficulties of their diagnosis and treatment constitute a challenge to global public health. To face this challenge, new anti-tuberculosis drugs, such as bedaquiline, pretomanid, and delamanid, as well as replacement drugs, such as fluoroquinolones, linezolid and clofazimine, are used. Based on the evidence provided by multicenter studies, drugs associated with a better prognosis of drug-resistant tuberculosis have been discovered and, recently, a new classification has been proposed, as well as new totally oral regimens. In this review, we describe current treatment regimens and practi cal pharmacological aspects required when prescribing new drug-resistant tuberculosis treatment regimens.

CHALLENGES IN INITIATION OF TREATMENT OF MULTI DRUG RESISTANT-TB PATIENTS: A HOSPITAL BASED CROSS SECTIONAL STUDY IN JHARKHAND.

BACKGROUND: Multi-drug resistant tuberculosis has become major public health problem and obstacle to effective control of tuberculosis. Over a period of time, there are several landmark achievements including policy and system preparedness for universal access to TB care including mandatory noti?cation of TB cases, development of standard for TB care in India, comprehensive real time TB information management system-NIKSHAY, use of rapid molecular diagnostics, successful innovations in private sector engagement for TB care-Universal access to TB care. Objective was to ?nd out the challenges in initiation of treatment of Multi Drug Resistant-TB patients get admitted in ITKI Sanatorium Ranchi Jharkhand. METHODS: It was a hospital based cross sectional study carried out from August 2016 to Nov.2018 on Multi drug resistant tuberculosis patients admitted in MDR-TB centre Itki Sanatorium Ranchi after approved from institutional ethics committee. Total study subjects included in study was 64. RESULTS: Most of the study subjects 58 (90.6%) did not know about the MDR-TB. Most of the study subjects 40 (62.5%) had been given reports of CB-NAAT test on same day followed by study subjects 24 (37.5%) on alternate day. No one study subjects 64 (100%) had been given any type of incentive for travelling to pretreatment evaluation centre. In above table, most of the patients 51 (79.7%) had made payment for investigations at district hospital/ SDH level followed by 13 (20.3%) who were free of any expenditure for investigations. Most of the study subjects 60 (93.7%) were not visited by any health staff between ?nal diagnosis of MDR-TB and initiation of treatment for MDR-TB followed by subjects 4 (6.3%) who were being visited by health staff. Most of the study subjects 48 (75%) were unaware about the NIKSHAY POSHAN SCHEME for MDR-TB patients followed by subjects 16 (25%) who knew about the NIKSHAY POSHAN SCHEME for MDR-TB patients by means of various medium.

Clinical Impact of the Line Probe Assay and Xpert® MTB/RIF Assay in the Presumptive Diagnosis of Drug-Resistant Tuberculosis in Brazil: A Pragmatic Clinical Trial

ABSTRACT Background: Rapid molecular methods such as the line probe assay (LPA) and Xpert® MTB/RIF assay (Xpert) have been recommended by the World Health Organization for drug-resistant tuberculosis (DR-TB) diagnosis. We conducted an interventional trial in DR-TB reference centers in Brazil to evaluate the impact of the use of LPA and Xpert. Methods: Patients with DR-TB were eligible if their drug susceptibility testing results were available to the treating physician at the time of consultation. The standard reference MGITTM 960 was compared with Xpert (arm 1) and LPA (arm 2). Effectiveness was considered as the start of the appropriate TB regimen that matched drug susceptibility testing (DST) and the proportions of culture conversion and favorable treatment outcomes after 6 months. Results: A higher rate of empirical treatment was observed with MGIT alone than with the Xpert assay (97.0% vs. 45.0%) and LPA (98.2% vs. 67.5%). Patients started appropriate TB treatment more quickly than those in the MGIT group (median 15.0 vs. 40.5 days; p<0.01) in arm 1. Compared to the MGIT group, culture conversion after 6 months was higher for Xpert in arm 1 (90.9% vs. 79.3%, p=0.39) and LPA in arm 2 (80.0% vs. 83.0%, p=0.81). Conclusions: In the Xpert arm, there was a significant reduction in days to the start of appropriate anti-TB treatment and a trend towards greater culture conversion in the sixth month.

Adverse drug reactions and treatment outcome analysis in multidrug resistant tuberculosis patients at a DOTS plus site

Background: Multidrug resistant tuberculosis (MDR TB) requires treatment with expensive, toxic, anti-tubercular drugs over a longer duration. Adverse drug reaction (ADR) to second line anti tubercular drugs affect compliance and hence treatment outcome. The primary objective of this study was to analyse ADRs and if these resulted in change or permanent suspension of drug. We also analysed treatment outcome, treatment adherence and co morbidities associated with MDR patients.Methods: A retrospective study was carried out at DOTS plus site in department of Pulmonary Medicine, Goa Medical College on registered MDR cases from November 2011 to October 2016. Socio demographic profile, diagnosis, treatment and ADRs were evaluated, ADRs were evaluated for frequency, causative drugs, management aspect and impact on treatment outcome.Results: Out of 201 MDR cases, 99 cases had 167 ADRs. Majority of patients having ADRs were in age group of 30-50 years with mean眘tandard deviation 36.82�.47, 59 (59.59%) males and 40 (40.40%) females, 92 (92.92%) retreatment cases and 7 (7.07%) newly diagnosed. Majority of ADRs were vomiting 31(18.56%), joint pain 31 (18.56%), gastritis 21 (12.57%), hearing impairment 16 (9.58%), numbness in leg 14 (8.38%), depression 12 (7.18%). Treatment outcome of cases with ADR was cured 45 (45.45%), treatment completed16 (16.16%), progressed to XDR 6 (6.06%), transferred out 5 (5.05%), defaulter 14 (14.14%), death 13 (13.13%).Conclusions: It is very important to recognise at the earliest and treat the ADRs with least modification of the treatment regimen to have a good treatment outcome.

A Study on Adverse Drug Reaction Profile of 2nd Line Drugs in Multi Drug Resistant (MDR) and Extensively Drug Resistant (XDR) Tuberculosis Cases Registered under DR-TB Centre in a Tertiary Care Hospital

The emergence of drug resistant mycobacterium has become a significant public health problem creating an obstacle to effective tuberculosis (TB) control. Freedom from TB is possible with timely, regular, complete treatment, with assurance, prevention and management of side effects of antitubercular drugs. Present study was conducted to evaluate common and rare adverse drug reactions (ADR) of CAT IV and CAT V to analyse demographic, radiological and bacteriological profile and treatment outcome in MDR & XDR patients. We wanted to evaluate the common and rare adverse drug reactions of intensive phase treatment of Multi Drug Resistant Tuberculosis (MDR) and Extensively Drug Resistant Tuberculosis (XDR) as per WHO-UMC Causality Assessment Scale.METHODS76 patients of MDR and XDR Tuberculosis were admitted in DR-TB (Drug Resistant TB) centre, Burdwan Medical College and Hospital and the adverse drug reaction profile of 2nd line drugs were analysed during the intensive phase from April 2016 to September 2017 after fulfilling the inclusion and exclusion criteria. Treatment was given as per the guidelines of Revised National TB Control Program PMDT (Programmatic Management of Drug-Resistant TB).RESULTSAdverse drug reactions on GI system were nausea 73 patients (96.10%), vomiting 70 (92.10%), acidity 41 (53.9%), and sulphurous belching and hepatitis 1 (1.31%) each. Peripheral neuropathy, hearing deficit, myopathy, skin rashes, hepatitis, nephrotoxicity, cardiac toxicity and convulsion were also observed. In psychosis, 3 (3.95%) had depression and made suicidal attempt. 1 each (1.31%) in hallucination and paranoia. 5 patients (6.58%) had blurring of vision, 2 patients (3.95%) had redness of eyes and one (1.31%) had eye irritation. Reactions were common in first 60 days of the regimen and in patients with BMI ≤18.CONCLUSIONSVigilant monitoring is required for these patients during the initial period and sputum smear and culture conversion is very well correlated with clinical and radiological improvement.

Study of Depression among MDR TB Patients - A Crossectional Observational Study

Introduction: Anti tuberculosis drug resistance is a majorpublic health problem that threatens progress made in TBcare and control. Globally prevalence of MDR TB(Multidrugresistance tuberculosis i.e.resitance to Isoniazid andRifampicin) is estimated around 4.1% in new cases and 19%in previously treated cases according to WHO report. Clinicaldepression is common but often neglected problem amongTB patients. This study was conducted to know problem ofdepression among MDR Tb patients. Aims and objectives ofthis study were to determine the prevalence of depression inpeople with TB at the time of anti-TB treatment initiation andto assess factors associated with baseline depression.Material and methods: It is a observational study conductedin tertiary care centre. After obtaining proper consent andethical consent data was collected using PHQ 9 score. Datawas analysed using appropriate statistical methods.Results: Out of total 100 patients 80% were PulmonaryTuberculosis(PTB) while 20% were ExtrapulmonaryTuberculosis (EPTB). Around 56% patients were male while44% were female. Prevalence of depression was 51%.Conclusion: Depression is common problem among MDRTB which is preventable and can be managed if identified atearly stage.

Frequency of first and second-line drug resistance-associated mutations among resistant Mycobacterium tuberculosis clinical isolates from São Paulo, Brazil

BACKGROUND Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis, and the number of new cases of multidrug resistant TB (MDR-TB), pre extensively drug-resistant TB (pre-XDR-TB) and extensively drug-resistant TB (XDR-TB) has increased considerably worldwide. OBJECTIVES Herein, using 156 M. tuberculosis isolates from 106 patients previously classified as MDR or pre-XDR or XDR isolates, we investigated the genetic mutation profiles associated with phenotypic resistances in patients with MDR-TB, pre-XDR-TB and XDR-TB, treatment outcomes and resistance evolution. METHODS Molecular analyses were performed by partial sequencing of the rpoB, katG, gyrA, gyrB, rrs genes and analysis of the fabG-inhA promoter region. Clinical, epidemiologic and demographic data were obtained from the TB Notification database system of São Paulo (TB-WEB) and the Information System for Special Tuberculosis Treatments (SITE-TB). FINDINGS Drug resistance was attributed to previously known mutations and a novel Asp449Val mutation in gyrB was observed in four isolates from the same patient. Ten patients had more than one isolate evaluated and eight of these patients displayed resistance progression. MAIN CONCLUSIONS The present study is the first to report the frequency of mutations related to second-line drug resistance in MDR-TB, pre-XDR-TB and XDR-TB isolates. The results could lead to the improvement of available technologies for the rapid detection of drug resistant TB.

Clinical profile of pulmonary tuberculosis and MDR TB in children at tertiary medical institute

Background: India is the country with highest burden of TB. There is paucity of data as far as Pediatric TB is concern. TB in children directly reflects intensity of on-going transmission of TB in a given community. This study was done including indoor cases of Pediatric pulmonary TB in a medical college hospital, a tertiary care institute in the city of Mumbai. The aim and objectives of this study the clinical profile and outcome of Pediatric pulmonary tuberculosis/MDR TB in an indoor setting of a tertiary care center. It was a clinical observational study in a setting of medical college hospital.Methods: All admitted children with newly diagnosed pulmonary TB were included in study. A detailed clinical analysis was done. Statistical Analysis Association between two qualitative data was assessed by Chi-Square test, Fisher's exact test for all 2 X 2 tables where Chi-Square test was not valid due to small counts. Comparison of quantitative data measured between two outcomes was done using unpaired t-test. PSPP version 0.8.5 was used for statistical analysis.Results: Total of 41 patients with pulmonary TB were included in the study, making admission rate of 0.7% of total admission. Three out of 41 children had MDRTB making incidence 7% of total TB patients. Severe acute malnutrition was a major risk factor for dissemination of disease and mortality (p value 0.031and 0.0017).Conclusions: The study estimates 0.7% admission rate and 7% as incidence of MDRTB in indoor patients. Severe malnutrition was found to be risk factor for dissemination of disease [p value 0.031].

To Study the Culture Conversion and XDR Suspect of Cat-IV Patients in DOTS Plus Site, S. N. Medical College, Agra

BACKGROUND - Multi-drug resistant tuberculosis (MDR-TB) is an increasing health problem in India. Globally,3.5% of new TB cases and 18% of previously treated cases had MDR/RR-TB.(GLOBAL TUBERCULOSIS REPORT 2018). As per the India TB Report 2018 the estimated incidence of  MDRTB/RR in India was approximately 1,47,000.Outcome of MDR patient put on MDR regime is poor due to high cost, long duration of treatment, and various side effect of second line ATT. MATERIAL & METHOD - Study comprised patients who were diagnosed MDR by culture and DST method from RNTCP accredited lab and initiated CAT–IV treatment in D.R.TB Centre, Department of Tuberculosis & Chest Diseases, S. N. Medical College, Agra. Detailed history and pre clinical evaluation as per guideline were done and at the end of 3rd ,4th,5th  and 6th month sputum  were send for AFB staining and culture. RESULT – Out of 109 MDR patient put on CAT-IV, culture conversion at 3rd month occur in 52(47.70%)  patients, at 4th month in 58 patients (53.21%), and in 5th month 66 patients (60.55%). Out of 109 MDR TB patients 12 patients (11.01%) were found suspected XDR. CONCLUSION – MDR TB is major health problem worldwide. Due to less efficacy and more side effect of second line ATT, longer duration of treatment, MDR TB is difficult to treat even with free supply of ATT through DOTS PLUS. Close attention is needed for early diagnosis  of MDR TB , and adequate clinically monitoring of during treatment is essential.

Progression from tuberculosis to multi drug resistance-TB in revised national tuberculosis control programme: perspectives from health system care givers

Background: The aims and objectives were to study the progression from tuberculosis to multi drug resistance-TB in revised national tuberculosis control programme: perspectives from health system care givers.Methods: The study was carried out in TB Sanatorium ITKI, Sadar Hospital Ranchi and RIMS Ranchi. The interview of various health personnel including SAHIYAs was taken using a semi-structured questionnaire based on programmatic management of multi drug resistant tuberculosis guidelines -2016.Results: Among Doctors knowledge level was good compared to other health personnel which had mean value 7.33 (±2.79), laboratory technician 3.45 (±2.64), STS 4.67 (±1.59), Sahiya 2.1 (±0.73). Regarding capacity enhancement level all health personnel needed refresher trainings in which doctors got 4.67 (±1.58), laboratory technician 3.45±2.64, STS 1.72±0.34, and Sahiya 0.5±0.52. Specially sahiya needs training regarding MDR-TB because they are the connecting link between health system and community. Regarding execution level, Doctors got 1.86 (±0.74), laboratory technician 1.64 (±0.56), STS 1.64 (±0.56) and Sahiya (ASHA) 2.2 (±0.44). Sahiya were better than other health personnel at execution level.Conclusions: Advocacy, communication, and social mobilization are important aspects of TB control, Policy makers and administrators should be sensitized for need of adequate and sustained funding for TB control to ensure quality capacity building. They need to provide continuous and quality training of staff at different levels and retention of trained staff and periodic reviews to identify gaps and take corrective steps.

Socio-demographic determinants of treatment outcome in multidrug resistant tuberculosis cases registered under Programmatic management of drug resistant tuberculosis services in Amritsar, Punjab

Background: Multidrug resistant tuberculosis (MDR-TB) has become a major public health problem. It is associated with significant morbidity and mortality. The treatment success rate worldwide is around 50%.Methods: This cross-sectional study was conducted on all MDR-TB patients who were registered and being treated under PMDT services in Amritsar district from 1st April 2014 to 31st March 2015. The treatment outcome with their socio-demographic determinants was ascertained. Data management and analysis was done by using Microsoft excel and SPSS.Results: Out of 87 MDR-TB patients, 57 (65.5%) were males and 30 (34.4%) were females. The various treatment outcomes observed were- 30 (34.5%) cured, 19 (21.8%) treatment completed, 18 (20.7%) died, 13 (14.9%) defaulted, 4 (4.6%) shifted to XDR TB regime and 3 (3.4%) failure.Conclusions: On statistical analysis, it was observed that age (p=0.000), marital status (p=0.024), educational status (p=0.011) and occupation (p=0.002) were significantly associated with the treatment outcome. Other factors like sex, type of family and socio-economic status did not affect the treatment outcome.

Role of line probe assay in diagnosis and detection of drug resistance in Mycobacterium tuberculosis

Tuberculosis caused by Mycobacterium tuberculosis has remained a major global health problem worldwide. TB requires prolonged period of time for isolation by conventional culture methods. The emergence and spread of multi drug resistant (MDR-TB) poses great threats and challenges in controlling the infection. MDR-TB is resistant to both first line drugs rifampicin and isoniazid. PCR tests are based on targeting the mutation in rpoB, katG and inhA genes which can detect resistance to these drugs. To compare microscopy, conventional culture and Line probe assay for the detection of M. tuberculosis & detect rifampicin and isoniazid resistance using Lineprobe assay in various clinical samples. A total of 347 suspected patients of tuberculosis were included in the study. Demographic details & clinical presentation was noted. Various samples were received & processed for ZN staining, culture on LJ media and Line probe assay. Out of 347 cases, majority of cases were in the age group of 51-60 years (18.4%). Majority of the population was males (65.1%). Among suspected tuberculosis patients, cough with expectoration (55.9%) was the commonest complaint. Microscopy was positive in 17.3%, conventional culture was positive in 16.1% and line probe assay was positive in 26.2%. Out of 347, 91 were diagnosed with MTB, out of which 85.7% were sensitive to both rifampicin and isoniazid whereas 14.3% showed resistance to either rifampicin / isoniazid or both. LPA & direct microscopy are a good screening method for early diagnosis and detection of drug resistance but are not a complete replacement of conventional culture which is still a gold standard.

An observational study to analyze predisposing factors, causality, severity and preventability of adverse drug reactions among multidrug resistant tuberculosis patients treated under RNTCP program in Northern India

Background: There were 4.1% of all new cases and 19% of previously treated patients were diagnosed with either multidrug resistant or rifampicin resistant tuberculosis in 2016. In the state of Uttar Pradesh, there were 2.16 new cases and 44,531 previously treated cases. The objectives of the study were to assess the predisposing factors, causality assessment, severity grading and avoidability of the adverse drug reactions (ADRs) of the antitubercular drugs in MDR-TB patients in a tertiary care hospital of northern India.Methods: This prospective observational study was conducted for 12 months at a tertiary care hospital. The patients with MDR tuberculosis on treatment with DOTS Plus regimen under RNTCP and who met the inclusion exclusion criteria were recruited after informed consent. ADRs were monitored daily till the patients remained admitted and thereafter monthly. Predisposing factors were recorded. Causality assessment was performed by Naranjo scale and WHO UMC scale, severity by Hartwig’s scale and avoidability by Halla’s scale.Results: There were 115 patients were recruited, 70 developed at least one ADR. 98 ADRs were reported. The commonest ADR reported were – gastrointestinal (38.76%), neurological (21.24%) and hepatobiliary (8.16%). Diabetes and HIV predisposed to development of ADRs. 58.18% ADRs were classified as possible and 37.5% as probable by Naranjo’s scale. 51.02% ADRs were classified as probable and 42.83% as possible by WHO-UMC. 56% were classified as mild, 36% moderate, and 6% severe via Hartwig’s scale. 51 ADRs were classified as avoidable and 40 ADRs were possibly avoidable.Conclusions: Monitoring and assessment of ADRs is necessary to promote awareness, curb resistance and maintain adherence.