Abstract
Background & Objectives: Emergence of drug resistant Tuberculosis (TB) is a major obstacle in the TB control programme of Bangladesh. This study was carried out to detect pre-extensively drug resistant TB (pre-XDR-TB) cases among the multidrug resistant TB (MDR-TB) patients in Bangladesh, as the early detection of pre-XDR-TB can guide clinicians in the appropriate modification of MDR-TB treatment regimen with effective drugs to prevent treatment failure. Methodology: A total of 68 MDR-TB cases were enrolled in this study. Multiplex Real-time PCR was done to detect pre-XDR-TB cases directly from sputum samples of MDR-TB patients. Results: Out of 68 MDR-TB cases 11 (16.18%) cases were detected as pre-XDR-TB. The resistant profile of the 11 pre-XDR-TB revealed 9 (81.82%) cases of fluoroquinolone (FLQ) resistant pre-XDR-TB and 2 (18.18%) cases of injectable second line (ISL) agent resistant pre-XDR-TB. Out of 11 pre-XDR-TB cases 7 (63.64%) cases had history of taking treatment for MDR-TB regularly, 1 (9.09%) case had history of taking treatment for MDR-TB irregularly and 3 (27.27%) cases had no history of taking treatment for MDR-TB. Conclusion: This study encountered a high rate of pre-XDR-TB cases along with a significant number of primarily resistant bacilli which is of concern in the management of MDR-TB. It is evident that Bangladesh is in urgent need to device strategies for rapid and early detection of pre-XDR-TB in order to prevent treatment failure of MDR-TB cases and also to halt the progression of MDR-TB cases to extensively drug resistant TB (XDR-TB), which is not only difficult but also very expensive to treat.
Highlights
Tuberculosis (TB) is a major public health problem in Bangladesh
Among the 68 multidrug resistant TB (MDR-TB) patients, 14 (20.59%) cases were PCR negative, 39 (57.35%) cases were detected as only MDR-TB and 11 cases were detected as pre-XDR-TB, of which 9 (13.24%) were FLQ resistant pre-XDR-TB cases, 2 (2.94%) were injectable second line (ISL) resistant pre-XDR-TB cases and the remaining 4 (5.88%) were XDR-TB cases
This study encountered a higher rate of pre-XDR-TB among pulmonary MDR-TB patients in Bangladesh
Summary
Tuberculosis (TB) is a major public health problem in Bangladesh. The estimated incidence rates for all forms of TB in 2015 were 225 per 100,000. Pre-XDR-TB cases with FLQ or ISL resistance receive less number of effective drugs under standard MDR-TB regimen. This study was carried out to detect pre-extensively drug resistant TB (pre-XDR-TB) cases among the multidrug resistant TB (MDR-TB) patients in Bangladesh, as the early detection of pre-XDR-TB can guide clinicians in the appropriate modification of MDR-TB treatment regimen with effective drugs to prevent treatment failure. Conclusion: This study encountered a high rate of pre-XDR-TB cases along with a significant number of primarily resistant bacilli which is of concern in the management of MDR-TB. It is evident that Bangladesh is in urgent need to device strategies for rapid and early detection of pre-XDR-TB in order to prevent treatment failure of MDR-TB cases and to halt the progression of MDR-TB cases to extensively drug resistant TB (XDR-TB), which is difficult and very expensive to treat
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