Gene mutation patterns of Mycobacterium tuberculosis complex and associated factors among suspected multidrug-resistant tuberculosis patients in Osun State, South-West, Nigeria

Abstract

Tuberculosis (TB) drug resistance has become a substantial public health threat, posing a significant challenge to global TB control. Nigeria is one of the eight countries contributing two-thirds of the global TB cases in 2020, with a high rate of MDR/RR-TB. This study was designed to determine MDR-TB prevalence among suspected drug-resistant TB patients, MTBC mutation patterns, and the associated factors of MDR-TB in Osun State. We obtained fresh sputum samples from eligible participants who tested positive for rifampicin resistance on GeneXpert assay for analysis using the MTBDRplus LPA. SPSS version 23 was used for statistical analysis, significance was set at p<0.05. We recorded a prevalence of 58.6 %, 37.1 %, and 2.9 % for MDR-TB, rifampicin and isoniazid mono-resistance. Majority of the MDR-TB cases were males (56.1 %), below 40 years (80.5 %), low-level education (75.6 %), unemployed (75 %), and low-income earners (64.1 %). ‘Previous TB treatment’ had a statistically significant effect on MDR-TB (P<0.001, OR=65.46). Other factors that showed a strong odds ratio but were not statistically significant included: age (OR=2.52, P = 0.09), diabetes (OR=1.99, P = 0.25), smoking history (OR=1.51, P = 0.43) and hypertension (OR=1.34, P = 0.63). There were 67 and 46 reactions of the wild-type and mutant bands for rpoB gene, eight wild-type and five mutant bands for katG gene, and six wild-type and 24 mutant bands for inhA gene. WT8/MUT3 (64.2 %), WT/MUT1 (61.5 %), and MUT1 (80 %) were predominant for rpoB, katG, and inhA genes, respectively, with the occurrence of D516V rpoB gene mutation for the first time in Osun State. There is a need for the reinforcement of the current TB care system, empowerment and monitoring of TB-caregivers for adequate and effective follow-up of TB patients, and more citizens awareness, especially regarding TB/MDR-TB treatments. This is expected to improve the management of MDR-TB patients and mitigate the development and spread of MDR-TB in the community.