To investigate the impact of revised diagnostic algorithm on presentation of multidrug-resistant tuberculosis cases at a referral centre in India

Abstract

ABSTRACT Introduction: A shift in policy has occurred with the introduction of molecular diagnostic tools for the upfront diagnosis of all cases of tuberculosis, including drug-resistant tuberculosis. The impact of this shift in policy on severity of disease was studied, and comparisons were drawn between the year 2015 and 2020. Study Type and Design: This was an observational study conducted between 2020 and 2021. Seventy patients of MDR-TB with or without additional drug resistance, hospitalized in the year 2015 and 2020, were studied. Results: The study reveals a substantial reduction in the median time from the onset of symptoms to diagnosis between 2015 and 2020. Specifically, the median duration decreased from 12 weeks in 2015 to 8 weeks in 2020. Moreover, we found that in 2015, all cases under study had a history of tuberculosis in comparison to 2020. Additionally, there was a higher incidence of anemia in 2015 compared to 2020. In the radiological examination, it was observed that in 2015, a higher frequency of cases exhibited cavitations, bronchiectasis, and fibrosis on chest X-rays compared to the findings in 2020. The mean cavity size in 2015 measured 6.73 cm, while in 2020, it averaged 4.06 cm. Additionally, we noticed a higher occurrence of significantly advanced cases in 2015 in contrast to 2020. Conclusion: The implementation of the new policy of upfront DST was noted to decrease the time required for diagnosis and bacterial load as ascertained from degree of sputum smear positivity, radiological lesions, and severity of anemia.