Clinical profile and risk stratification in multidrug-resistant tuberculosis (MDR-TB) and non-MDR-TB patients: A prospective study in a tertiary care hospital

Kumar Ns,Priyashree R,Gopal Kv,Gadwalkar Rs

doi:10.17727/jmsr.2021/9-30

Abstract

Background: Multidrug resistant tuberculosis (MDR-TB) is a major threat for successful control of TB. Early diagnosis and drug sensitivity testing helps in improving disease prevalence. This study was undertaken to determine clinical profile and risk factors for MDR-TB and factors differentiating it from non MDR-TB. Materials and methods: This is a prospective study conducted at a TB hospital attached to Vijayanagara institute of medical sciences, Bellary, Karnataka in South India over a period of 2 years. All patients diagnosed with MDR-TB were studied for clinical parameters and another cohort of non MDR-TB in same study period were included for comparison. Clinical and radiological characteristics, and risk factors were compared between two groups. Results: A total of 59 MDR-TB and 72 non MDR-TB patients were studied in this period. Males were predominant in both groups. Body mass index (BMI) was significantly low in MDR-TB group (18.5 vs 20.3 kg/m2). Among clinical symptoms, breathlessness was significantly seen in MDR-TB group. Defaulter, failure and relapse were seen in 6.8%, 54.3% and 37.3% respectively. Cavitary lesions and reticulonodular patterns in imaging were significantly seen in MDR group. Eight patients in non MDR group had human immunodeficiency virus (HIV) infection compared to one patient in MDR. Conclusion: Presence of cavity and reticulonodular patterns in imaging, significant breathlessness and lower BMI are significantly common in MDR TB patients. These parameters maybe considered for early suspicion and monitoring for drug resistance in index presentation. Keywords: multidrug resistant TB; breathlessness; human immunodeficiency virus; cavity lesion; reticulonodular patterns

Highlights

Multi drug resistant tuberculosis (MDR-TB) is defined as tuberculosis (TB) with resistance to at least rifampin and isoniazid
Breathlessness was significantly seen in Multidrug resistant tuberculosis (MDR-TB) group
Eight patients in non MDR group had human immunodeficiency virus (HIV) infection compared to one patient in MDR

Summary

Introduction

Multi drug resistant tuberculosis (MDR-TB) is defined as tuberculosis (TB) with resistance to at least rifampin and isoniazid. The treatment is longer and requires more toxic drugs than non MDR-TB [1, 2]. An useful incentive in this aspect is to predict those patients who are at risk of this challenging MDR-TB, so as to subject them for further testing and treating them in initial part of disease. Several risk factors have been associated with MDR-TB. Risk profile and prognosis may vary compared to non MDR-TB patients. There is scarcity in data understanding how MDR-TB patients differ in clinical profile as compared to patients with drug sensitive TB. Little is known about the relative contribution of clinical and other risk factors in high prevalence settings. Diagnosis and drug sensitivity testing helps in improving disease prevalence. This study was undertaken to determine clinical profile and risk factors for MDR-TB and factors differentiating it from non MDR-TB

Methods

Results

Discussion

Conclusion