Drug-resistant Pulmonary Tuberculosis Patients Research Articles

Resistance Patterns in Drug-Resistant Pulmonary Tuberculosis Patients at Dr. Mohammad Hoesin Palembang Hospital

Resistance Patterns in Drug-Resistant Pulmonary Tuberculosis Patients at Dr. Mohammad Hoesin Palembang Hospital

The Longer the Therapy, the Worse the Severity of the Adverse Drug Reactions that Occur in Drug-Resistant Pulmonary Tuberculosis Patients

BackgroundIt is estimated that drug-resistant (DR) Tuberculosis (TB) (DR-TB) patients in Indonesia are 2.40% of all new TB patients and 13% of previously treated TB patients with a total incidence of DR-TB cases of 24,000 people. The adverse drug reactions (ADRs) of DR-TB are still a problem that can certainly affect the success of therapy. The aim of this study was to determine the correlation between the length of therapy and regimen therapy of DR-TB with the severity of ADRs. MethodsData collection was carried out retrospectively on the medical records of DR-TB patients in 2020–2021 and sampling used a purposive sampling technique that complied with the inclusion criteria. ResultsOf the 86 patients, the majority of DR-TB patients in X Hospital were 26–45 years old 35 (40.7%), 52 (60.5%) male, the most common comorbid was type II DM, 19 (22.1%), and the most nutritional status was malnutrition as much as 39 (45.3%). The most common type of ADR was hyperuricemia in 31 (36.0%). The results of the correlation analysis showed that there was a relationship between the length of therapy and the severity of ADRs (ρ = 0.002) and there was no relationship between the type of therapy regimen and the severity of ADRs (ρ = 0.184). ConclusionThe longer DR-TB therapy, the higher the severity of ADRs and there is no relationship between the type of therapy regimen and the severity of ADRs.

ORAL LICHEN PLANUS IN DRUG-RESISTANT PULMONARY TUBERCULOSIS PATIENT: A RARE CASE

Drug-resistant pulmonary tuberculosis (DR-TB) is a hurdle in controlling pulmonary tuberculosis. The mucocutaneous tissues, including the oral mucosa, can be impacted by DR-TB medication, although infrequent. Highlighting Oral Lichen Planus (OLP) as a rare oral finding of drug side effects in DR-TB patients. Two male patients in DR-TB Clinic RSUD Tangerang City were referred to the Oral Medicine Clinic for complaints in the oral cavity. Treatment for DR-TB was given to the patient in months 8 and 11. The microscopic examination and sputum culture were negative when consulted. The patient denied any oral cavity complaints before being diagnosed with DR-TB. The intraoral clinical examination showed erosive lesions with a white keratinized plaque on the lips, buccal mucosa, labial mucosa, and tongue consistent with OLP. Pharmacological management involved using corticosteroids for mouthwash and lip ointment with responsive results. Scheduled oral hygiene was also planned to eliminate focus infection in the oral cavity. OLP is a chronic inflammation of the oral mucosa mediated by immunological mechanisms and triggered by various agents. Drugs are one of the known triggers of OLP lesions. The findings of side effects in the oral mucosa tissue are believed to be a result of the DR-TB regimen of these two patients. Long-term drug use triggers the development of OLP in patients with DR-TB. OLP is an oral mucosa finding of drug side effects that is rarely reported in DR-TB patients.

Risk factors of treatment interruptions among drug-sensitive and drug-resistant pulmonary tuberculosis patients - A study from South Delhi, New Delhi, India

BackgroundA variety of factors influence adherence to the lengthy duration of anti-tuberculosis treatment, making it a complicated and dynamic problem. The objective of this study was to investigate the treatment interruption patterns using pre-defined criteria among a cohort of pulmonary tuberculosis patients and to elicit the associated factors. MethodsThis prospective, observational study was conducted between October 2016 to May 2018. All smear and culture positive pulmonary tuberculosis patients (age ≥ 14 years) enrolled between October 1, 2016 to March 31, 2017 across 3 Designated Microscopy Centers (DMCs) were included and followed up till end of treatment for outcome in drug-sensitive, and till interim outcome at 6 months for drug-resistant TB patients. Patterns and reasons for interruptions were recorded as per the study protocol. Results171 patients were enrolled in this study, of which 135 (78.94 %) were on Category-I and Category-II treatment (drug-sensitive tuberculosis), 23 (13 %) were multidrug-resistant (MDR) and 13 (8 %) were extensively drug resistant (XDR) tuberculosis patients. Among the drug-sensitive group, 65 (48 %) patients completed their treatment without any interruption while 70 (52 %) patients interrupted with at least one missed dose. Among the 36 MDR/XDR patients, 19 (53 %) patients did not interrupt treatment, but 17 (47 %) patients interrupted with at least one missing dose. The 87 patients in both sub-groups interrupted for 232 times/episodes of which 140 were short and 84 were long interruptions. The main reasons for interruption were found to be busy schedule in 63 (29 %) patients, adverse drug reactions in 40 (18.4 %) and comorbidities in 43 (19.8 %) patients. Feeling of early improvement/no improvement in 23 (10.5 %) patients, addictions in 27 (12.4 %) patients, lack of family support in 14 (6.4 %), unawareness of dosage and duration of treatment in 7 (3.20 %) patients were other common reasons. ConclusionThe plurality of patients studied were found to be in the younger age group i.e., 14–25 years (n = 75), constituting nearly 44 % of all the patients included and male treatment interrupters (62 %) outnumbered the females (38 %), possibly owing to work schedule or addictions. The majority of interruptions were related to patient related factors (93.5 %), followed by DOTS provided factors (6.40 %) and system related factors (3.01 %). Further studies should be conducted to classify the factors of treatment interruptions in detail and also to study the impact of these interruptions’ patterns on final outcomes.

Long-Term Intake of Linezolid Elevates Drug Exposure and Reduces Drug Clearance and Elimination in Adults With Drug-Resistant Pulmonary Tuberculosis.

Pharmacokinetic (PK) studies are critical for dose optimization, and there is a paucity of linezolid (LZD) PK data for prolonged use in drug-resistant tuberculosis (DR-TB). Therefore, the authors evaluated the pharmacokinetics of LZD at two-time intervals in DR-TB during long-term use. PK evaluation of LZD was performed at the end of the 8th and 16th weeks of treatment in a randomly selected subset of adult pre-extensively drug-resistant pulmonary tuberculosis patients (n = 18) from a multicentric interventional study (Building Evidence to Advance Treatment of TB/BEAT study; CTRI/2019/01/017310), wherein a daily dose of 600 mg LZD was used for 24 weeks. Plasma LZD levels were measured using a validated high-pressure liquid chromatography (HPLC) method. The LZD median plasma C max was comparable between the 8th and 16th weeks [18.3 mg/L, interquartile range (IQR: 15.5-20.8 and 18.8 mg/L, IQR: 16.0-22.7, respectively)]. However, the trough concentration increased significantly in the 16th week (3.16 mg/L, IQR: 2.30-4.76), compared with the 8th week (1.98 mg/L, IQR: 0.93-2.75). Furthermore, compared with the 8th week, in the 16th week, there was a significant increase in drug exposure (AUC 0-24 = 184.2 mg*h/L, IQR: 156.4-215.8 versus 233.2 mg*h/L, IQR: 187.9-277.2), which corroborated with a longer elimination half-life (6.94 hours, IQR: 5.55-7.99 versus 8.47 hours, IQR:7.36-11.35) and decreased clearance (2.91 L/h, IQR: 2.45-3.33 versus 2.19 L/h, IQR: 1.49-2.78). Long-term daily intake of 600 mg LZD resulted in a significant elevation in trough concentration (>2.0 mg/L) in 83% of the study participants. Furthermore, increased LZD drug exposure may be partly because of decreased clearance and elimination. Overall, the PK data underscore the need for dose adjustment when LZDs are intended for long-term treatment.

Adverse drug reactions in drug resistant pulmonary tuberculosis patients

This study is conducted from year 2019–2022 in Gujarat Cancer Society medical college and research center, Ahmedabad. Out of total 275 patients on drug resistant TB regimen (all oral longer, shorter injectable and mono H) seen in opd, 55 patients presented with adverse drug reaction. Most commonly affected age group was 20–40 yr old. During the course of treatment 32.7% required hospitalization, of which 29% were admitted in ward, rest required ICU care. Maximum ADR occurred in first 30 days of starting ATT. Drug had to be withdrawn in 41.81% and in 32.7%, offending agent was withdrawn permanently. There was no mortality during the study.

Audiometric Profile of Patients on Treatment for Drug-Resistant Pulmonary Tuberculosis in Owerri, South-East Nigeria.

Background: Tuberculosis is an existential medical challenge in certain parts of the world necessitating global efforts. Perhaps more challenging is the treatment of drug-resistant forms of the disease as this requires use of second line drugs, predominantly potentially ototoxic aminoglycosides. The hearing impairment so caused, besides constituting social disability, can impair compliance and have far-reaching consequences. This study aimed at assessing the hearing patterns of patients on treatment for drug-resistant pulmonary tuberculosis to determine if, and to what extent their treatment affected their hearing status. Patients and method: The study was an 18-month prospective analysis of consecutive newly diagnosed drug-resistant pulmonary tuberculosis patients in a tertiary hospital in Owerri, Nigeria. Baseline audiometry was conducted on the patients with subsequent monthly audiometry for 3 months during treatment. A control group drawn from normal population and matched for age and sex with the study group was recruited and audiometry performed on the participants in similar pattern. The audiometric patterns of both groups were analyzed and compared using Statistical Package for Social Sciences (SPSS) version 20.0 software for Windows. Statistical significance was set at p< 0.05. Results: Thirty-eight (38) patients treated for drug-resistant pulmonary tuberculosis completed the study alongside thirty-eight (38) control subjects with M:F ratio was 1.53:1. The baseline prevalence of hearing impairment of any sort was 73.7% and 68.4% among the test and control groups respectively, whereas after three months it was 89.5% and 68.4% respectively. The cumulative incidence of hearing loss over three months was 15.8% and 0% respectively. This difference was statistically significant. Conclusion: Treatment of drug-resistant tuberculosis with second line drugs can lead to significant hearing impairment within the first three months of treatment.

Sputum smear conversion and treatment outcomes among drug-resistant pulmonary tuberculosis patients in eastern Ethiopia: A 9-years data analysis.

Drug-resistant tuberculosis (DR-TB) has become a public health problem throughout the world and about one-third of deaths were attributed to DR-TB from antimicrobial resistance which contributes to 10% of all TB deaths. Sub-Saharan Africa, particularly Ethiopia accounts for a significant number of TB cases. However, the scanty evidence on DR-TB contributing factors could affect the level of this deadly case tackling program. Therefore, this study aimed to assess the factors affecting sputum smear conversion and treatment outcomes among patients with DR-TB in Health facilities in Eastern Ethiopia. A cross-sectional study design was employed from 10 October to 10 November 2021, in the health facilities providing DR-TB services in Harari Region and Dire Dawa city administration. The medical records of 273 DR-TB patients from 10 January 2013 to 27 December 2021, were reviewed using structured checklists. Data were entered into Epidata 3.1 version and exported to STATA 14 version for analysis. The outcome variables were Initial Sputum conversion (converted vs. not-converted) and treatment outcome (Unfavorable vs. Favorable). Sputum examination was performed using both Acid-fast bacillus (AFB) smear microscopy and Löwenstein-Jensen (LJ) culture technique. A binary logistic regression analysis was used to assess the association of independent variables with the first month sputum smear conversion, while a conditional logistic regression model was used to assess the association of treatment outcome with explanatory variables. The associations were reported using adjusted odds ratios (AORs) at a 95% confidence interval. A total of 273 DR-TB patients were included in this study. The unfavorable DR-TB treatment outcome was significantly associated with the history of chewing khat (AOR = 4.38, 95% CI = 1.62, 11.84), having bilateral lung cavity on baseline chest X-ray (AOR = 12.08, 95% CI = 1.80, 2.57), having greater than 2+ smear result at baseline (AOR = 3.79, 95% CI = 1.35, 10.59), and poor adherence (AOR = 2.9, 95% CI = 1.28, 6.82). The sputum smear non-conversion at first month was significantly associated with being Human Immune Virus (HIV)-negative (AOR = 0.37, 0.17, 0.82), having low baseline BMI (AOR = 0.54, 95% CI = 0.29, 0.97), baseline culture > 2++ (AOR = 0.15, 95% CI = 0.05, 0.49) and having greater than 2+ sputum smear result (AOR = 0.09, 95% CI = 0.012, 0.67). Patients with normal chest X-ray at baseline had 3.8 times higher chance of sputum smear conversion on first month (AOR = 3.77, 1.11, 12.77). The overall initial sputum smear conversion and the treatment success rate among DR-TB patients were 52.75 and 66.30%, respectively. The Baseline underweight, HIV-negative, baseline smear > 2+, baseline culture > 2++, and clear lung on baseline X-ray were associated with smear conversion and history of khat chewing, bilateral lung cavity at baseline, having greater than 2+ smear results at baseline, and patients with poor treatment adherence had hostile treatment outcomes. So, strengthening and implementing nutrition assessment and patient counseling during directly observed therapies (DOTs) service and drug compliance could result in early sputum conversion and better treatment outcomes. DR-TB patients with high bacterial load and abnormal lungs on radiologic examination at baseline could need special attention during their course of treatment.

The Characteristics and Patterns of Drug-Resistant Pulmonary Tuberculosis in Eastern India.

Background: Drug-resistant tuberculosis is a major public health problem throughout the world and accounts for substantial morbidity and mortality rates in India, too. Early diagnosis is the corner stone of tuberculosis treatment. State-level and cluster-wise variations in drug resistance is a possibility and should be regularly checked in from time to time. Materials and Methods: The present prospective cohort study (January 2019 to May 2022) was conducted in Darbhanga Medical College and Hospital on drug-resistant pulmonary tuberculosis patients. Sputum specimens were collected from designated centers. Rapid molecular drug-resistance testing (genotypic tests) and growth-based drug-susceptibility testing (DST) (phenotypic tests) were performed in the National Tuberculosis Elimination Program certified Laboratory. Results: A total of 268 patients with drug-resistant pulmonary tuberculosis were included in the study group. The treatment outcomes revealed as cured in 100 (37.31%); treatment completed in 43 (16.04%); died in 56 (20.89%); treatment failed in 22 (8.21%); loss of follow up in 34 (12.69%); and transferred out in 13 (4.85%) drug-resistant pulmonary tuberculosis patients. Adverse events were recorded in 199 (74.25%) of the drug-resistant pulmonary tuberculosis patients. Conclusions: Drug-resistant pulmonary tuberculosis patients are a matter of concern and need to be addressed.

Chest X-ray findings in drug-sensitive and drug-resistant pulmonary tuberculosis patients in Uganda

BackgroundTuberculosis (TB) is one of the leading causes of death worldwide. Radiology has an important role in the diagnosis of both drug-sensitive (DS) and rifampicin-resistant (RR) pulmonary TB (PTB). This study aimed to compare the chest x-ray (CXR) patterns of microbiologically confirmed DS and RR PTB cases stratified by HIV serostatus in Uganda. MethodsWe conducted a hospital-based retrospective study at the Mulago National Referral Hospital (MNRH) TB wards. All participants had a microbiologically confirmed diagnosis of PTB. CXR findings extracted included infiltrates, consolidation, cavity, fibrosis, bronchiectasis, atelectasis, and other non-lung parenchymal findings. All films were examined by two independent radiologists blinded to the clinical diagnosis. ResultsWe analyzed CXR findings of 165 participants: 139 DS- and 26 RR-TB cases. The majority (n = 118, 71.7%) of the participants were seronegative for HIV. Overall, 5/165 (3%) participants had normal CXR. There was no statistically significant difference in the proportion of participants with consolidations (74.8% versus 88.5%; p = 0.203), bronchopneumonic opacities (56.1% versus 42.3%, p = 0.207) and cavities (38.1% versus 46.2%, p = 0.514), across drug susceptibility status (DS versus RR TB). Among HIV-infected participants, consolidations were predominantly in the middle lung zone in the DS TB group and in the lower lung zone in the RR TB group (42.5% versus 12.8%, p = 0.66). HIV-infected participants with RR TB had statistically significantly larger cavity sizes compared to their HIV uninfected counterparts with RR TB (7.7 ± 6.8 cm versus 4.2 ± 1.3 cm, p = 0.004). ConclusionsWe observed that a vast majority of participants had similar CXR changes, irrespective of drug susceptibility status. However, HIV-infected RR PTB had larger cavities.The diagnostic utility of cavity sizes for the differentiation of HIV-infected and non-infected RR TB could be investigated further.

Chest X-Ray Findings in Drug Sensitive and Drug Resistant Pulmonary Tuberculosis Patients in Uganda

Chest X-Ray Findings in Drug Sensitive and Drug Resistant Pulmonary Tuberculosis Patients in Uganda

ЭФФЕКТИВНОСТЬ ПРИМЕНЕНИЯ ТЕХНОЛОГИИ ПЦР В РЕАЛЬНОМ ВРЕМЕНИ ДЛЯ ЭКСПРЕСС-АНАЛИЗА ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТИ МИКОБАКТЕРИЙ ТУБЕРКУЛЕЗА К ПРЕПАРАТАМ 1-ГО РЯДА В КЛИНИЧЕСКИХ ОБРАЗЦАХ МОКРОТЫ И БИОПТАТАХ ТКАНИ ЛЕГКИХ, ПОЛУЧЕННЫХ ВО ВРЕМЯ ОПЕРАЦИИ*

The objective of the study : to investigate the effectiveness of real-time PCR for express drug susceptibility testing in drug resistant pulmonary tuberculosis patients using sputum samples and specimens of lung tissue collected during surgery. Subjects and methods . 231 sputum samples and 240 biopsy specimens collected during surgery were tested with the use of real-time PCR and multi-competitive allele-specific real-time PCR. Results : the positive results of testing for MTB DNA were obtained in 72.7% of respiratory samples, of which in 61.9%, the number of genomic DNA copies was sufficient for drug susceptibility testing; positive results were observed in 93.3% of biopsy specimens, and in 93% of them the drug resistance of tuberculous mycobacteria was tested. The difference in the effectiveness of drug susceptibility testing of biopsy specimens and respiratory samples was statistically significant: p < 0.01. When testing respiratory samples, multiple drug resistance (MDR) was detected in 42.3% of cases, and when testing biopsy specimens, MDR was detected in 34.4% of cases. The high effectiveness of real-time PCR and multi-competitive allele-specific real-time PCR was demonstrated when testing biopsy specimens and performing express drug susceptibility testing in tuberculosis patients after surgical treatment.

High degree of fluoroquinolone resistance among pulmonary tuberculosis patients in New Delhi, India.

Background & objectives:The fluoroquinolones (FQs) group of antibiotics is the backbone drugs for the management of drug-resistant tuberculosis (TB). In routine clinical practice, drug susceptibility testing (DST) for FQs is not performed, and the patients are empirically treated. A limited information exists regarding FQs resistance among pulmonary TB cases. The present study was conducted to determine the FQs resistance among drug sensitive and drug-resistant pulmonary TB patients in a tertiary care centre in north India.Methods:A total of 1619 sputum/smear-positive specimens of pulmonary TB patients were subjected to DST for first-line drugs (FLDs) and second-line drugs. In addition, FQs DST was also performed using automated Mycobacterial Growth Indicator Tube-960 liquid culture technique. The immuno-chromatographic assay was performed to distinguish Mycobacterium tuberculosis complex (MTBC) from non-MTBC.Results:Mycobacterium tuberculosis (Mtb) was isolated in 1499 sputum specimens; 1099 culture specimens were sensitive to FLDs, 249 grew as multidrug-resistant (MDR) Mtb and the remaining 151 isolates revealed any drug resistance to FLDs. While FQs monoresistance among the FLD sensitive isolates was 3.1 per cent (35/1099), 27.3 per cent (68/249) among MDR Mtb isolates had additional FQs resistance.Interpretation & conclusions:FQs resistance among drug sensitive and MDR Mtb isolates was high in Delhi, India. Based on these findings, it is recommended that the DST for FQs should be routinely performed to avoid further amplification of drug resistance.

Human Beta Defensin 1 (hbd1) Levels in Sputum and Lysate of Mononuclear Blood Cells of Drug-Sensitive and Drug-Resistant Pulmonary Tuberculosis Patients Attending a Tertiary Hospital in Ibadan, Nigeria.

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Follow up of Drug-Resistant Pulmonary Tuberculosis Patients in a DRTB Center in First Fifteen Months of Treatmen

Background and Objective: Multidrug-resistant tuberculosis (MDR-TB) is defined as resistant to both INH and Rifampicin with or without resistance to other first-line antitubercular drugs. The aim of the study was to assess the sputum culture conversion rate during first 12 months of treatment in drug-resistant TB patients, to assess the impact of comorbid illnesses and other factors on culture conversion by following up the patients up to 15 months after initiation of treatment. Materials and Methods: This was a prospective study comprising of 142 diagnosed patients of drug-resistant TB admitted in this center from April 2014 to March 2015 for treatment initiation, excluding extrapulmonary TB and already diagnosed extensively drug-resistant tuberculosis (XDR-TB). After pretreatment evaluation, standard second-line antitubercular drug (CAT-IV) was started. Patients were followed up in first 15 months of treatment. Results of sputum culture for mycobacteria at 3rd, 4th, 5th, 6th, 7th, 9th and 12th months after treatment initiation were analyzed. Results: Sputum culture for mycobacteria was converted negative within one year in 95 cases (67%); whereas 18 patients died during follow up, 27 defaulted and 2 patients switched over to CAT-V after development of extended drug-resistance during follow up. Conclusion: Though drug-resistant tuberculosis (DRTB) is one of the biggest challenges to public health program in India, treatment with standardized second-line drugs under RNTCP have a favorable outcome as indicated by sputum culture conversion of as many as 67% of patients within one year in this study.

Assessment of palliative patients with chemoresistance pulmonary tuberculosis life quality in the conditions of specialized hospital at the corrective labour colony

Objective – to evaluate the quality of life of palliative patients with drug-resistant pulmonary tuberculosis at a specialized hospital penal colony in terms of the questionnaire of the MOS SF-36 and justify the appropriateness of its application for a differentiated approach in dependence of physical or mentally health components oppression, monitoring their health status. Materials and Methods. Quality of life assessment was performed in 95 patients with drug-resistant pulmonary tuberculosis who were treated in a specialized tuberculosis hospital at the penal colony. 53 patients of them were on palliative treatment and included into main observation group and comparison group consisted of 42 patients who received antimycobacterial chemotherapy in the maintenance phase of treatment. To determine the norms of quality studied indicators in our region, we have formed a control group consisted of 40 healthy volunteers. For quality of life assessment the questionnaire of the MOS SF-36 was used. Results. Increase the intensity of pain in palliative patients with drug-resistant pulmonary tuberculosis contributes physical functioning limitation. Acute emotional instability (depression, anxiety and negative emotions) with limited social activity causes low self-esteem of mental state. Such changes ultimately result in inhibition of the viability and general health deterioration. For these patients particular attention should be paid to such scale of life quality assessment asPF,VT and MH as they were significantly lower compared with those drug-resistant pulmonary tuberculosis patients with antimycobacterial chemotherapy in maintenance phase of treatment. Conclusions. Drug-resistant tuberculosis in patients who are in palliative care leads to a drastic reduction of all quality of life parameters. Using the questionnaire of the MOS SF-36 for quality of life in palliative patients with drug-resistant pulmonary tuberculosis assessment is reasonable for a differentiated approach in dependence of physical or mentally health components oppression, health monitoring of these patients.

Assess drug resistance pattern and genetic profile of Mycobacterium tuberculosis clinical isolates by molecular typing methods using direct repeats and IS6110 in pulmonary tuberculosis cases.

Background:Tuberculosis (TB), a highly contagious disease that sees no gender, age, or race is mainly a disease of lungs. According to World Health Organization, a TB patient can be completely cured with 6–9 months of anti-TB treatment under directly observed treatment short course.Objectives:The aim of this study was to check the mono, multi- and triple-drug resistance to first line drugs (FLDs) among TB patients and to access their genetic profile using DR 3074, DR 0270, DR 0642, DR 2068, and DR 4110 using molecular techniques.Material and Methods:To gain a better understanding of drug resistant TB, we characterized 121 clinical isolates recovered from 159 drug resistant pulmonary tuberculosis patients by IS6110 genotyping. MTB isolates recovered from HIV- negative, and smear positive cases of both genders, age varied from 18 to 70 years with drug resistant-TB that was refractory to chemotherapy given for > 12 months. Of a total of 159 sputum smear positive patients sum number of male and female patients was 121 (76.10%) and 38 (23.89%), respectively. Among these patients, number of literate and illiterate patients were 123 (77.3%) and 36 (22.6%). 25 (15.7%) patients had farming as their occupation, 80 (50.3%) had nonagricultural occupation and 54 (33.9%) women were housewives.Results:Mono drug resistant, multi-drug resistant, and totally drug resistant (TDR) cases of TB were calculated as 113.83%, 125.1%, and 67.9%. Isoniazid showed the highest percentage of resistance among the patients.Conclusion:Any noncompliance to TB medications, lack of knowledge, and poor management in health centers, etc., results in the emergence of deadly direct repeat forms of TB, which are further complicated and complex to treat.

Utility of Line Probe Assay for the Early Detection of Multidrug-Resistant Pulmonary Tuberculosis.

Background:Despite endorsement of the line probe assay (LPA) for the diagnosis of drug-resistant pulmonary tuberculosis patients, there is limited data available on the performance of LPAs in India, especially from high burden states like Maharashtra, for the early diagnosis and detection of drug resistance, in order to initiate timely and appropriate treatment.Objective:To evaluate the utility of the line probe assay (LPA) for the early diagnosis of drug-resistant pulmonary tuberculosis as compared to the ‘Gold standard’ 1% proportion method (PM).Materials and Methods:A total of 687 patients suspected of pulmonary tuberculosis were screened. One hundred samples (95 sputum and 5 BAL), positive for Acid Fast Bacilli (AFB) by Ziehl Neelson (ZN) smears, were included in the study. Digested and decontaminated specimens were subjected directly to the LPA (Genotype MTBDR@ plus assay) and were processed in parallel using the conventional culture on the Lowenstein-Jensen (LJ) medium followed by drug susceptibility testing (DST) using the PM.Results:All the 100 samples gave interpretable results on LPA with a turnaround time of 24-48 hours as opposed to six to eight weeks taken by the 1% proportion method. Sensitivity for the detection of rifampicin, isoniazid, and multidrug resistance (MDR) was 98.1, 92.1, and 95%, respectively, with a specificity of 97.8% for rifampicin and 98.33% for MDR detection. It also had the additional advantage of allowing a study of mutation patterns.Conclusions:High performance characteristics and a short turnaround time makes LPA an excellent diagnostic tool, for an early and accurate diagnosis, in a high MDR- TB-prevalent region, as reflected from our data.

Dysregulation of homeostasis of blood T-lymphocyte subpopulations persists in chronic multibacillary pulmonary tuberculosis patients refractory to treatment

Design: The dysregulation of homeostasis of blood-T lymphocyte subpopulations was studied in 21 cases of chronic, multibacillary pulmonary tuberculosis refractory to treatment. The clinico-bacteriological and immunological parameters studied in these cases (Gr A) were compared with those of a group of 10 newly-diagnosed drug sensitive cases of pulmonary tuberculosis (Gr B) at the beginning of the study and after 3 months of chemotherapy for tuberculosis. The chronic cases were treated with drugs selected from a reserve line. 10 normal healthy individuals were included in this study as a control group. Results: At the beginning of the study the mean CD4/CD8 lymphocyte ratios in the refractory cases (0.69) and the newly diagnosed cases (0.81) were significantly lower than those of the normal control subjects (1.84). After 3 months of chemotherapy all but 3 of the newly-diagnosed cases showed clinical improvement, and all became sputum-negative. Their CD4 CD8 ratio recorded a rise to near normal (1.54). On the contrary, following 3 months of reserve-line regimen, only 7 of the 21 group A cases showed sputum conversion. In all of the refractory cases, irrespective of sputum conversion, the CD4 CD8 ratio remained low (1.05). Conclusion: This probably indicates that due to a long-standing bacillary load in drug resistant pulmonary tuberculosis patients the dysregulation of homeostasis of blood-T lymphocytes becomes persistent. This in turn delays their clinical and immunological recovery, even when therapy is adequate.

The Chemothera putic results of the secondary anti-tuberculous drugs for pulmonary tuberculosis patients

The problem, how to manage so-callcd chronic far-advanced drug resistant pulmonary tuberculosis patients, attracted the new attention of chest clinicians and investigators and many trails have been made to solve the problem.Since the advent of P. Z. A. by Kushner (1952) many secondary antituhcrculous drugs includingC.S., K.M. and 1314 TH appeared in rapid succession and seemed to give new enthusiasm.The author has made a study on the effect of various secondary anti-tuberculous drugs including C.S., P.Z.A,K.M. Abcid , and T.M. in the group of chronic pulmonary tuberculosis patients resistant against three principle drugs (S.M. ,I.N.H., P.A.S.) and summarised the results as follows.1) Among 96 patients of medical cases.Roentgenological improvement was made in 39.0% for C.S. group, 28.6% for P.Z.A., 9.1% for K.M.,8.7% for Abcid, respectively and most of the improvement was only slight in degree.2) The sputum conversion rate was very poor, only two cases, one is C.S. group another is P.Z.A. group.3) The symptomatic improvements were most excellent in C.S. group, that is. about two third of the patients among C.S. group showed improvement of one or more subjective symptoms.4) The side reactions were most frequent in P.Z.A. group, and two cases of severe joint pain and one casc of aunte hepatitis were most haza dous. The occurrence of the neuropsychiatric disorder with C.S. and the damagc of Vlll nerve with K. M. not significant in this sludy.5) Among 75 patients of surgery combined, the sputum conversion rate was 100% except of dead cases immediately after operation.6) The occurrence of complication after operation was 34.5% in the principle drug resistant group and it was as high as other reports. (Adrews. Sweetman) Over-all operation mortality rate was 5.06%.7) The over-all conclusion of this study is the secondary anti-tuberculosis drugs at present have some effects in the management of chronic. principle drug resistant pulmonary tuberculosis patient but not so much optimistic as many author's reports.