Abstract
BackgroundThe diagnoses of active smear negative PTB, remains difficult. As a result, treatment is often carried out empirically relaying on clinical criteria. The distribution and magnitude of smear negative PTB, smear negative MDR-TB and associated factors in the same day diagnosis strategy are not clearly known in the study area. Therefore, this study aimed to determine the prevalence of TB, MDR-TB and associated risk factors among presumptive smear negative pulmonary tuberculosis patients in Addis Ababa, Ethiopia.MethodsAnalytic cross sectional study design was used. A total of 418 smear negative presumptive pulmonary TB patients were enrolled from selected health facilities since August 01, 2017 to January 5, 2018. Sputum samples were examined by Ziehl Neelsen microscopy, Xpert MTB/RIF assay and Culture. Drug susceptibility testing was performed by line probe assay and BACTEC MGIT 960 system. These laboratory tests were performed in Ethiopian Public Health Institute, National TB Reference Laboratory. Data was analyzed by SPSS Ver.20.ResultsFrom the total of 418 enrolled patients, 27 (6.5%) were Xpert MTB/ RIF and 26 (6.4%) were culture confirmed smear negative PTB patients. The positivity rate among male and female was 10.2 and 3.5% (p = 0.005) respectively. From 26 culture positive isolates 3 (11.54%) were MDR TB; from MDR-TB confirmed isolates 2/23 (8.7%) were among new and 1/3 (33.3%) was among retreatment smear negative presumptive pulmonary TB patients. All Rifampicin resistant smear negative pulmonary TB isolates by Xpert MTB/ RIF assay were found to be MDR TB and 7/26 (26.9%) isolates were INH mono resistant. History of migration found to be a potential factor for developing smear negative pulmonary TB.ConclusionIn this study a significant proportion of smear negative pulmonary TB was diagnosed. Furthermore, a high smear negative multi drug resistant (MDR) TB and other mono drug resistant TB prevalence was confirmed. Due to the limitations of smear microscopy which is used as a primary diagnostic tool, these TB strains are missed to be diagnosed and transmission continues in the community.
Highlights
The diagnoses of active smear negative Pulmonary tuberculosis (PTB), remains difficult
Prevalence of smear negative pulmonary tuberculosis (SNPT) SNPT prevalence among presumed smear negative PTB patients was 6.5% (95% C.I, 4.103–8.816) by Xpert Mycobacterium tuberculosis (MTB)/RIF assay
Our study showed high prevalence of SNMDR TB in comparison with a study in India that was conducted among newly diagnosed sputum-positive pulmonary tuberculosis between February 2008 and December 2009 demonstrated very low prevalence that was 1.13% multi drug resistant (MDR)-TB
Summary
The diagnoses of active smear negative PTB, remains difficult. As a result, treatment is often carried out empirically relaying on clinical criteria. This study aimed to determine the prevalence of TB, MDR-TB and associated risk factors among presumptive smear negative pulmonary tuberculosis patients in Addis Ababa, Ethiopia. In 2017 alone, 10 million people have developed TB disease [1]. TB is the leading cause of death in the world among infectious diseases [1]; 1.3 million died among HIV negative and 300, 000 among HIV positive people due to TB by the year 2017 [1]. If treatment is not initiated, a person with TB disease will infect an average of 10–15 other people every year [2]. In 2014 the national prevalence of MDR-TB was 2.3% among new and 17.8% among previously treated patients [6]
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