Molecular Detection of Resistance to Rifampin and Isoniazid among Patients Eligible for Retreatment Regimen in C&amp;#244;te d’Ivoire in 2012

Kouassi N’Guessan,Jean-Serge Assi,André Guei,Jean-Marc Assande,Jacquemin Kouakou,Timothée Ouassa,André Tehe

doi:10.4236/aid.2013.32010

Abstract

Drug-resistant tuberculosis is an important health problem in Cote d’Ivoire. Patients of category I treatment are based on 2RHZE/4RH regimen. For the patients of category II, the 2RHZES/1RHZE/5HRE regimen is systematically initiated. Study objective was to describe the susceptibility profile to Rifampin and Isoniazid among previously treated patients who are eligible for retreatment and who had received the 2RHZES/1RHZE/5HRE regimen in Cote d’Ivoire with a molecular method in 2012. Two sputum samples were collected to each patient recruited in the reference regional centres for tuberculosis. Sputum samples were decontaminated by NALC method. The DNA extraction was realized with 500 μl of decontaminated sputum sample with smear-positive. MTBDRplus assay version 1.0 was performed according to the manufacturer’s instruction. An internal quality control program with positive and negative controls was implemented for interpretation of results. A total of 278 patients were enrolled, 148 (53.2%) were recurrent TB cases, 118 (42.5%) failure cases, and 12 (4.3%) defaulters. From sputum of previously treated patients, mutli-drug resistant tuberculosis was diagnosed for 60 (69.8%, 95% IC, 60% - 80%) treated with the 2RHZE/4RH regimen, 24 (75%, 95% IC, 60% - 90%) with the 2RHZES/1RHZE/5HRE regimen, 60 (41%, 95% IC, 33% - 49%) recurrent TB cases, and 4 (33.3%) defaulters. The comparison of resistance rates to Rifampin estimated from sputum samples in the categories of treatment failures and the recurrence TB cases showed a statistically significant difference. In Cote d’Ivoire, genotype? MTBDRplus assay has permitted to estimate the prevalence of MDR-TB in categories of previously treated patients for tuberculosis.

Highlights

Drug-resistant tuberculosis has emerged as an important global public health threat
Two sputum samples were collected to each patient recruited in the reference regional centres for tuberculosis
Sputum samples were decontaminated by NALC method

Summary

Introduction

Drug-resistant tuberculosis has emerged as an important global public health threat. Rapid diagnosis of tuberculosis and multidrug-resistant (resistance to at least Rifampin and Isoniazid) is an important challenge to ensure a rapid and adequate therapy of tuberculosis and to limit the dissemination of multiresistant strains [1]. Rifampin and Isoniazid are the cornerstones of first-line drugs used for treatment of tuberculosis. Culture and drug-susceptibility testing are not available the essential information for detection, follow-up and management of antibiotic resistance in M. tuberculosis cannot provide by laboratories. Prevalence of MDR-TB has been estimated to be low in sub-Saharan Africa, where surveillance of drug resistance is limited notably [1]. In Côte d’Ivoire, prevalence of MDR-TB cases among new cases with a positive smear decreased from 5.3% to 2.5% respectively from 1995 to 2006 [2]

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Conclusion