DETECTION OF MYCOBACTERIUM TUBERCULOSIS AND DRUG RESISTANCE IN PEDIATRIC PATIENTS SUSCEPTED OF PLEURAL TUBERCULOSIS

Abstract

The main purpose of this study is the detection of Mycobacterium tuberculosis (MTB) and its drug resistance profile by molecular methods in pediatric patients suspected of pleural tuberculosis. Children ≤ 15 years of age suspected of pleuritis were enrolled in this study. Total 176 pleural fluid samples were collected from January to June 2018 and tested for AFB microscopy, GeneXpert and MGIT culture. Of 176 samples, total 14 (8%) samples were positive for MTB and 1 (7.1%) was observed MDR-TB. Smear microscopy detected AFB in 2 (1.1%) cases only. GeneXpert and MGIT culture showed 6 (3.4%) and 12 (6.8%) positive cases respectively, out of, 1 (16.7%) was found rifampicin resistant by GeneXpert. Of culture positives, 1 (8.3%) was MDR-TB 8 1 (8.3%) was found isoniazid mono-resistant by first line LPA. Sensitivity and specificity of GeneXpert by using MGIT culture as gold standard was found to be 33.3% and 98.8% respectively. MDR-TB observed by GeneXpert was 16.7%. Among 12 culture positive isolates, only one (8.3%) isolate was found MDR-TB and one (8.3%) was isoniazid mono-resistant. Results of Geno Type MTBDRsl assay showed that only one (50%) isolate was fluoroquinolones resistant and sensitive to second line injectable drugs. None of the isolate was Extensively Drug Resistant (XDR). GeneXpert can provide rapid immediate diagnosis of MTB and rifampicin resistant which can help in giving proper treatment but simultaneous culture also needs to be done as it missed many cases. It’s important to look for drug resistance as 16.7% isolates were rifampicin resistant.