Drug-resistant Tuberculosis Patients Research Articles

Prevalence and Patterns of Drug-Resistant Tuberculosis in Patients Receiving Drug Sensitive Anti-Tubercular Medications within and Outside the DOTS at Nodal DRTB Center, SNMC, Agra

Prevalence and Patterns of Drug-Resistant Tuberculosis in Patients Receiving Drug Sensitive Anti-Tubercular Medications within and Outside the DOTS at Nodal DRTB Center, SNMC, Agra

Assessment of risk factors associated with drug-resistant tuberculosis in pulmonary tuberculosis patients

IntroductionTuberculosis remains a global health problem worldwide and the risk progression of Tuberculosis to Drug Resistant Tuberculosis is influenced by various factors. These include immunocompromised status, past history of tuberculosis, life style and nutritional level. Hence, identifying the population at risk of multidrug-resistant tuberculosis is essential and may help in developing appropriate case-finding strategies. Therefore, the present study was designed to study the contributing risk-factors associated with Drug resistant Tuberculosis. Materials and methodsIn this prospective observational study, we assessed 189 Pulmonary tuberculosis diagnosed patients during the period of 2 years at government recognized tertiary care centers. Data was collected from all these patients checked to investigate risk factors associated with Drug resistant tuberculosis development by multivariant analysis. ResultsOf the 189 participants, 36 were diagnosed with drug resistant tuberculosis and 153 with drug sensitive tuberculosis. Factors associated with drug resistant tuberculosis include low-weight (OR 8.50; p = 0.0008430991), low-BMI (p = 0.0000527166), lower economic status (OR-2.1351; p = 0.048608696) and tobacco (OR-4.5192; p = 0.0023003189) were found clinically and statistically significant in development of drug resistant tuberculosis. Binary logistic regression was performed to ascertain the effects of various statistically significant factors. Drug resistant tuberculosis patients were 7.77 times more likely to be tobacco users than drug sensitive tuberculosis. ConclusionsOur study suggests that, there is a compelling and urgent need for increasing public awareness, initiating better nutrition and food programs, regular screening, and better management & control of MDR-TB.

Time-to-Treatment Initiation in a Decentralised Community-Care Model of Drug-Resistant Tuberculosis Management in the OR Tambo District Municipality of South Africa.

Drug-resistant tuberculosis (DR-TB) continues to challenge global efforts toward eradicating and having a tuberculosis-free world. Considering the high early mortality, especially among HIV-infected individuals, early diagnosis and prompt initiation of effective treatment are needed to significantly reduce mortality and halt transmission of DR-TB in the community. This study aims to assess the effectiveness of a community DR-TB care model with the specific objective of determining the Time-to-treatment initiation of DR-TB among patients in the OR Tambo district municipality. A prospective cohort study of patients with DR-TB was conducted in the OR Tambo district municipality of Eastern Cape Province, South Africa. Patients were enrolled as they presented for treatment initiation at the decentralised facilities following a diagnosis of DR-TB and compared with a centralised site. A total of 454 DR-TB patients from six facilities between 2018 and 2020 were included in the analysis. The mean age was 37.54 (SD = 14.94) years. There were slightly more males (56.2%) than females (43.8%). Most of the patients were aged 18-44 years (67.5%), without income (82.3%). Results showed that slightly over thirteen percent (13.4%) of patients initiated treatment the same day they were diagnosed with DR-TB, while 36.3% were on the time-to-treatment target of being initiated within 5 days. However, about a quarter (25.8%) of patients failed to initiate treatment two weeks after diagnosis. Time-to-treatment initiation (TTTI) varied according to the decentralised sites, with progressive improvement with each successive year between 2018 and 2021. No demographic factor was significantly associated with TTTI. Despite rapid diagnosis, only 36% of patients were initiated on treatment promptly. Operational challenges remained, and services needed to be reorganised to maximise the exceptional potentials that a decentralised community DR-TB care model brings.

Investigation of efflux pump genes in isoniazid resistant Mycobacterium tuberculosis isolates

BackgroundTuberculosis (TB) is one of the most important infectious diseases worldwide. Resistance to antituberculosis drugs develops because of genetic mutations that render drug-activating enzymes inactive, changes in cell wall permeability, and increased expression of efflux pump genes and also combination therapy with efflux pump inhibitors may be more effective in drug-resistant TB patients. AimsTo investigate the effect of verapamil (VR) on isonicotinic acid hydrazide (INH) resistance and the expression of 21 efflux pump genes in INH monoresistant MTBC clinical isolates. Study designIn vitro study. MethodsIn our mycobacteriology laboratory, 10 INH monoresistant and 10 primary anti-TB drug-susceptible MTBC clinical isolates were selected. Drug susceptibilities for INH and VR were studied by resazurin microtiter plate method and minimum inhibitory concentration (MIC) was determined. Additionally, mRNA gene expressions were investigated by quantitative Real Time Polymerase Chain Reaction for 21 efflux gene regions. ResultsWhile no change was observed in INH MICs of susceptible isolates under VR effect, 6 (60%) of the 10 INH-resistant isolates showed a decrease of less than one dilution in INH MIC under VR effect. VR significantly reduced resistance in resistant isolates (p ​< ​0.05). INH monoresistant MTBC isolates showed a 2.85-fold expression increase in the Rv1634 region of the Major Facilitator Superfamily efflux family under INH stress (p ​= ​0.029). No statistically significant change was observed in other efflux gene regions. Herein, increased expression was observed in the Rv1634 region, consistent with other studies in the literature, and this was associated with drug resistance. No significant change in expression was detected in other gene regions. ConclusionThe effect of efflux pump inhibitor VR on INH MIC levels is promising for the treatment of resistant TB. However, studies with more resistant strains are needed to evaluate the efficacy of efflux pump genes.

Risk Factors For Treatment-Induced Hearing Impairment: Perspective From A Resource-Poor African Setting

Background - Treatment-induced hearing impairment can result from prolonged administration of potentially ototoxic medications often in the pharmacotherapeutic management of chronic illnesses such as drug-resistant tuberculosis. Whereas drug ototoxicity may be idiosyncratic, it is imperative to be aware of its potential risk factors while treating patients. We aimed in our study to identify risks factors for hearing impairment in patients treated for drug-resistant pulmonary tuberculosis at our Centre. Patients and methods – This study was a 24-month prospective study of drug-resistant tuberculosis patients treated at the pulmonology unit of Federal Medical Centre, Owerri, Nigeria. Each patient had pure tone audiometry before commencement of treatment (baseline) and after three months of treatment for comparison. Clinical data was obtained using pre-tested examiner-administered questionnaire. Data collected was analyzed with SPSS version 25.0 and statistical significance set at p &lt; 0.05. Results - Thirty-eight (38) participants completed the study with a male-to-female (M:F) ratio of 1.53:1. The modal age group was 41-50 years and median duration of presenting complaints 9.9 weeks. HIV seroprevalence was 18.4% among the study participants. The baseline prevalence of hearing impairment was 73.7% but increased to 89.5% after three months of treatment with a cumulative incidence of 15.8% which was statistically significant (p &lt; 0.001). The identified risk factors for hearing impairment were age (&gt;50 years), family history of hearing impairment, kanamycin administration and BMI &lt;18.5kg/m2 . Conclusion – Kanamycin was associated with more severe hearing impairment than capreomycin. Advancing age, family history of hearing impairment and BMI &lt; 18.5kg/m2 were risk factors for development of hearing impairment in patients treated for drug-resistant tuberculosis in our setting.

Characteristics of plasma exosomes in drug-resistant tuberculosis patients

BackgroundIncreasing prevalence of drug-resistant tuberculosis (DR-TB) poses a major challenge to the early detection and effective control of tuberculosis (TB). Exosomes carrying proteins and nucleic acid mediate intercellular communication between host and pathogen including Mycobacterium tuberculosis. However, molecular events of exosomes indicating the status and development of DR-TB remain unknown. This study determined the proteomics of exosome in DR-TB and explored the potential pathogenesis of DR-TB. MethodsPlasma samples were collected from 17 DR-TB patients and 33 non-drug-resistant tuberculosis (NDR-TB) patients using grouped case-control study design. After exosomes of plasma were isolated and confirmed by compositional and morphological measurement for exosomal characteristics, a label-free quantitative proteomics of exosomes was performed and differential protein components were determined via bioinformatics analysis. ResultsCompared with the NDR-TB group, we identified 16 up-regulated proteins and 10 down-regulated proteins in the DR-TB group. The down-regulated proteins were mainly apolipoproteins and mainly enriched in cholesterol metabolism-related pathways. Apolipoproteins family including APOA1, APOB, APOC1 were key proteins in protein-protein interaction network. ConclusionDifferentially expressed proteins in the exosomes may indicate the status of DR-TB from NDR-TB. Apolipoproteins family including APOA1, APOB, APOC1 may be involved in the pathogenesis of DR-TB by regulating cholesterol metabolism via exosomes.

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.

Psychiatric Manifestation in Drug-Resistant Tuberculosis Patients

Psychiatric Manifestation in Drug-Resistant Tuberculosis Patients

Assessment of anxiety and depression among tuberculosis patients of Ahmedabad, India

BackgroundIndia has high prevalence of Tuberculosis (TB). The long duration of treatment and chronic nature of illness predispose a person to anxiety as well as depression. Various addiction habits may affect treatment outcome and impact mental wellbeing in TB patients. This study was planned with the objectives of finding prevalence of anxiety and depression in tuberculosis patients at Ahmedabad district and to find association between anxiety, depression and different variables of TB patients as well as to assess the addiction profile of TB patients. MethodsA total of 600 TB patients above 18 years and having completed 3 months of anti TB treatment without any psychiatric illness were selected randomly from 3 types of health institutes where patients receive treatment namely Ahmedabad district TB center (Institute 1), one medical college attached hospital (Institute 2) and one private hospital (Institute 3).Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. ResultsThe mean age of study patients was 41.57 ± 13.44 years and 66.3% (398) patients were males. The prevalence of anxiety and depression was found to be 37.5% and 41.2% respectively while in 18.66% patients both anxiety and depression coexisted simultaneously. Institute 1 reported highest prevalence of anxiety (45.4%) while institute 2 reported highest prevalence of depression (42.9%). The prevalence of anxiety among drug sensitive TB patients was 32.7% while among drug resistant TB patients was 80%.The prevalence of depression in drug sensitive TB patients was 37.03% while among drug resistant TB patients was 78.3%. Anxiety had a statistically significant association with gender, occupation, socioeconomic class, type of TB, site of TB and perceived social isolation (p < 0.05).Except gender, depression was significantly associated with all the variables (p < 0.05).Tobacco addiction was found in 37.5% patients, alcohol addiction in 8.3% while 4.5% patients had both types of addiction. There was a statistically significant association found between addiction and variables like gender, residence, occupation, type of TB and site of TB. ConclusionOne third of patients had anxiety and more than one third had depression in which the prevalence of depression was higher than anxiety. District TB Center had highest prevalence of anxiety while medical college attached hospital had highest prevalence of depression. Anxiety and depression were higher in drug resistant TB patients. Tobacco addiction was more common than alcohol. Addiction had a significant association with depression, nonworking rural males and patients who had drug resistant pulmonary TB.

Predictors of mortality among drug-resistant tuberculosis patients in Kaduna State, Nigeria.

Specific death due to DR-TB has significantly contributed to tuberculosis (TB) mortality and overall global deaths. This study examines the predictors of mortality among DR-TB patients in Kaduna State, Nigeria. This was a retrospective longitudinal study of DR-TB mortality carried out among 370 DR-TB patients from the 23 LGAs in Kaduna State. It involves a retrospective review of the MDR-TB records of the patients over a period of 10 years (2012-2021). Demographic and clinical data of all DR-TB patients enrolled in Kaduna State, Nigeria, between April 1, 2012, and March 31, 2021, were used. Survival analysis was performed with SPSS version 25, using Kaplan-Meier and Cox proportional hazard regression modeling, at 5% significance level. The majority of the patients, 255 (68.9%), were below the age of 40 years, while 53 (14.3%) of the patients died within the study period. Most deaths 26 (49.1%) were associated with HIV co-infection and the disease severity. Results for the Cox proportional model show that there was a significantly lower risk of death when a patient had MDR-TB compared to pre-XDR-TB (adjusted hazard ratio, AHR = 0.34, 95% CI = 0.16-0.72, P = 0.04). Both models show that age, sex, residence, or year of treatment had no significant association with survival or death. HIV co-infection and DRTB with progression to more resistant and difficult-to-treat strains contributed to higher deaths. There is a need for concerted efforts from all DR-TB stakeholders to control the disease.

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.

Drug hypersensitivity in drug-resistant tuberculosis

ObjectiveTo evaluate drug resıstant tuberculosis patients who developed drug hypersensitivity to antituberculosis drug. MethodsThis was a retrospective study. The primary aim of the study is to determine the demographic and clinical characteristics of patients who develop drug hypersensitivity in drug resistant tuberculosis patients. The secondary aim of the study is to examine the treatment results. Demographic features, tuberculosis diagnostic indicator, clinical signs of developing hypersensitivity reaction, reaction time, and treatment were evaluated. ResultsA total of 25 patients were included in the study. The prevalence of hypersensitivity in drug resistance patients was 11.9%. Twelve (48%) of the cases were women. Mean age (mean ± SD) was 37.24 ± 14.44 years; early type hypersensitivity reaction in 13 (52%). Three patients were isoniazid resistant; 19 patients were multidrug-resistant (MDR); 2 patients were pre-extensive drug resistant (Pre-XDR), 1 patient was extensive drug resistance (XDR) tuberculosis. The most common skin findings were maculopapular eruption and urticaria. But also we had seen ısole angıodema, urtıcarıa and angıoedema, erythema multıforme, lıchenoıd drug eruptıon and drug rash with eosinophilia and systemic symptoms. In patients who developed a hypersensitivity reaction, the responsible agent was identified in 14 cases in total. Among the drugs, pyrazinamide, ethambutol, moxifloxacin, amikacin, para amino salicylic, prothionamide, and cycloserine are the responsible agents. When evaluated in terms of treatment results, 15 (60%) patients successfully completed the treatment. ConclusionOur study is the first study in the literature that evaluated the drug hypersensitivity in drug resıstance tuberculosis patients. Drug hypersensitivity that develops with tuberculosis treatment may lead to discontinuation or change in treatment. İt can cause treatment failure, drug resistance, relapse, and even death. In resistant tuberculosis, the already existing resistance pattern may become more difficult to treat. Success can be achieved with the right management in these patients who have few treatment options, more drug side effects, and high treatment failure rates. The established regimen should be curative and prevent recurrence.

Studying the estimation levels of inflammatory markers and NF-κB in MDR and DS-TB patients

Tuberculosis (TB) is one of the most infectious and deadly diseases, especially after the emergence of drug-resistant bacteria. Therefore, in this study, we developed a method to evaluate the ability of using CXCL10, CXCL9, MMP9, suPAR and the expression gene (NF-κB) and their rolesin the diagnosis and treatment of the disease in patients. Also, we used ELISA and qPCR techniques to compare the serum levels of CXCL10, CXCL9, MMP9, suPAR and NF-κB gene in drug resistant and drug sensitive TB. The serum levels of CXCL10, CXCL9, MMP9, suPAR and the expression of NF-κB gene was compared among drug resistant and drug sensitive TB using ELISA and qPCR Techniques, respectively. Our results showed an increasing in the serum levels of CXCL10, CXCL9 and suPAR, in the drug resistant of TB patients but not in the drug sensitive group, however, all of them did not reach the significant level, it was found that expression of NF-κB in drug sensitive group was higher (3.22-fold) than that in the drug resistant-TB patients (2.70-fold).

Early efficacy of individual regimens containing bedaquiline in patients with drug resistant tuberculosis

Objective: To evaluate early efficacy of sputum conversion within 6 months of individual regimens containing bedaquiline in patients with drug resistant tuberculosis. Methods: We conducted a retrospective study among patients with drug resistant tuberculosis who were receiving individual regimens containing bedaquiline. The primary outcome was sputum conversion of both smear and culture within 6 months of treatment. We used medical records of drug resistant tuberculosis patients from January 2020 to December 2021. The study was conducted at Dr. Soetomo Hospital, Indonesia from August to October 2022. Results: In this study, 44 eligible drug resistant tuberculosis patients were initiated on regimens containing bedaquiline. There were 52.3% males and the median age was 45.5 years. The rates of previous treatment (70.5%) and lung cavity (36.4%) were high. The most common companion drugs included clofazimine, cycloserine, levofloxacin, and linezolid. Sputum smear and culture conversion was seen in 79.4% and 82.1% at the 2nd month, respectively. More than 97% patients had smear and culture conversion at the end of 6 months. Conclusions: Among drug resistant tuberculosis patients, individual regimens containing bedaquiline were associated with high rates of smear and culture conversion at the end of 6 months. Early efficacy of regimens containing bedaquiline can be used to predict cure rate at the end of treatment.

Unfavorable treatment outcomes among patients with drug-resistant TB in Uganda.

BACKGROUND: Drug-resistant TB (DR-TB) remains a significant public health burden and a threat to the progress made in TB control and prevention in sub-Saharan Africa.OBJECTIVE: To determine the risk-predictors of poor treatment outcomes in patients with DR-TB in Uganda.METHODS: We retrospectively reviewed medical records of adult Ugandans who had been treated for DR-TB at Mbarara Regional Referral Hospital (MRRH) in Uganda.RESULTS: Of the 385 files reviewed, 332 (86.2%) met the study inclusion criteria. Of these, 226 (68.1%) were men and 193 (58.1%) were HIV-positive. A total of 73 participants (22.7%) had unfavorable treatment outcomes (treatment failure, loss to follow-up or death). History of cigarette smoking (OR 5.10, 95% CI 2.4-11.4; P < 0.001), age >60 years (OR 6.32, 95% CI 2.2-18.6; P < 0.001), anemia (OR 2.38, 95% CI 1.1-5.3; P = 0.02) and thrombocytopenia (OR 3.60, 95% CI 1.6-8.1; P < 0.001) were independent predictors of unfavorable treatment outcomes.CONCLUSION: There is a high prevalence of unfavorable treatment outcomes among patients with DR-TB. Further research is required to design a prognostic model for DR-TB patients in a resource-limited setting.

Shorter regimens improved treatment outcomes of multidrug-resistant tuberculosis patients in Tanzania in 2018 cohort.

In 2018, shorter treatment regimens (STR) for people with drug-resistant tuberculosis (DR-TB) were introduced in Tanzania and included kanamycin, high-dose moxifloxacin, prothionamide, high-dose isoniazid, clofazimine, ethambutol and pyrazinamide. We describe treatment outcomes of people diagnosed with DR-TB in a cohort initiating treatment in 2018 in Tanzania. This was a retrospective cohort study conducted at the National Centre of Excellence and decentralised DR-TB treatment sites for the 2018 cohort followed from January 2018 to August 2020. We reviewed data from the National Tuberculosis and Leprosy Program DR-TB database to assess clinical and demographic information. The association between different DR-TB regimens and treatment outcome was assessed using logistic regression analysis. Treatment outcomes were described as treatment complete, cure, death, failure or lost to follow-up. A successful treatment outcome was assigned when the patient achieved treatment completion or cure. A total of 449 people were diagnosed with DR-TB of whom 382 had final treatment outcomes: 268 (70%) cured; 36 (9%) treatment completed; 16 (4%) lost to follow-up; 62 (16%) died. There was no treatment failure. The treatment success rate was 79% (304 patients). The 2018 DR-TB treatment cohort was initiated on the following regimens: 140 (46%) received STR, 90 (30%) received the standard longer regimen (SLR), 74 (24%) received a new drug regimen. Normal nutritional status at baseline [adjusted odds ratio (aOR)=6.57, 95% CI (3.33-12.94), p < 0.001] and the STR [aOR=2.67, 95% CI (1.38-5.18), p=0.004] were independently associated with successful DR-TB treatment outcome. The majority of DR-TB patients on STR in Tanzania achieved a better treatment outcome than on SLR. The acceptance and implementation of STR at decentralised sites promises greater treatment success. Assessing and improving nutritional status at baseline and introducing new shorter DR-TB treatment regimens may strengthen favourable treatment outcomes.

The differences in drug resistance between drug-resistant tuberculosis patients with and without diabetes mellitus in northeast China: a retrospective study

BackgroundDiabetes mellitus (DM) and drug-resistant tuberculosis (DR-TB) are serious global public health problems. This study aimed to explore the differences in drug resistance between DR-TB patients with and without DM. Risk factors for developing multidrug-resistant tuberculosis (MDR-TB) were also investigated among DR-TB patients.MethodsThe patient’s basic demographic, clinical characteristics, and drug susceptibility testing (DST) data were collected from the Chinese Disease Control Information System. Descriptive statistics were used to estimate the frequency and proportion of included variables. Categorical variables were compared using the Chi-square test or Fisher’s exact test. Chi-square tests for trends were used to determine changes and trends in MDR-TB and pre-extensively drug-resistantTB (pre-XDR-TB) patterns over time. Univariate and multivariate logistic regression analysis was used to explore the risk factors of MDR-TB.ResultsCompared with DR-TB patients with DM, DR-TB patients without DM had significantly higher rates of mono-resistant streptomycin (SM) and any resistance to kanamycin (KM), but significantly lower rates of any resistance to protionamide (PTO) and mono-resistance to levofloxacin (LFX), and pre-XDR-TB (P<0.05). The proportion of resistance to other anti-TB drugs was not statistically different between the DR-TB with and without DM. Among DR-TB patients without and with DM, the proportion of patients with MDR-TB and pre-XDR-TB patterns showed a significant downward trend from 2016 to 2021 (P<0.05). Among DR-TB patients without DM, male, previously treated DR-TB cases, and immigration were risk factors for MDR-TB (P<0.05). In DR-TB patients with DM, a negative sputum smear is a risk factor for MDR-TB (P<0.05).ConclusionThere was no statistical difference in resistance patterns between DR-TB with and without DM, except in arbitrary resistance to PTO and KM, mono-resistant SM and LFX, and pre-XDR-TB. Great progress has been made in the prevention and control of MDR-TB and pre-XDR-TB. However, DR-TB patients with and without DM differ in their risk factors for developing MDR-TB.

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&lt; 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.

Treatment outcome of drug-resistant tuberculosis (DR-TB) following uptake of universal drug susceptibility testing: A record review from a nodal DR-TB center

Background: There has been delay evident in diagnosing the drug resistance and non-initiation of appropriate treatment based on drug susceptibility pattern resulting in poor treatment outcome of drug-resistant tuberculosis (DR-TB). Aims and Objectives: The aims of this study were to examine the treatment outcomes for DR-TB patients following universal drug susceptibility testing (UDST) and to examine the association of sociodemographic, behavioral factors, or comorbidities with outcome. Materials and Methods: A retrospective study at a nodal DR-TB center was done for the past 2 years (2018–2019) following the district’s adoption of UDST. The study comprised patients registered between January 2018 and December 2019. Transferred out cases were excluded from the analysis. Cured or treatment completed were assigned as successful, whereas the treatment failed, lost to follow-up or died were adverse treatment outcome. Results: A total of 201 patients were initiated on suitable DOTS regime and they continued the treatment from the center, during the study period. Altogether 129 (64.2%) patients had successful treatment outcome. None of the examined variable (age, sex, SES, Body mass index, and comorbidity) is found to have statistically significant association with outcome (P&gt;0.05). Conclusion: The UDST may be the reason for success rate shown here, higher than in literature published. Although a better stance is possible only by comparing the treatment outcome of pre- and post-uptake of UDST from same setting.

Modelling Outcome of Drug Resistant Tuberculosis and Drug Susceptible Tuberculosis Patients in Oyo State

TB is perhaps the most important contagious disease in the world and the leading cause of mortality by an infectious disease. As a result, WHO declared that achieving the reduction in TB incidence rate for achievement of the 90-90-90 target of the END-TB strategy will be an illusion, if something severe is not done. Therefore, it is imperative to assess the visibility of achieving the END-TB goal in the country (Nigeria) by assessing the success of TB treatments so far in the country. Hence, this paper aims to model the outcome of drug-resistant-tuberculosis and drug-susceptible-tuberculosis patients in Oyo state of Nigeria using the logit function of estimating binary logistic regression model vis-à-vis identifying the success of these TB treatments. At baseline, based on WHO categorization, the study revealed the commonest cases of patients receiving DS-TB seen are ‘New’ (90.5%) followed by relapse after failure (4.2%). Contrarily, the commonest cases of patients receiving DR-TB seen are treatment after failure (44.3%), new (27.5%) and relapse after failure cases (20.6%). Four months after starting treatment, 91.5% and 3.2% were reportedly alive and dead respectively for patients receiving DS-TB treatment while 85.3% and 11.5% were reportedly alive and dead respectively for receiving DR-TB treatment. Hence, the percentage success of DS-TB recorded was higher than the recorded for DR-TB patients. Furthermore, the chi-square results for DS-TB patients indicated that mortality significantly associated with DS-TB categorised patients (i.e. Relapse) and HIV status (i.e. Negative). Also, for the DR-TB patients, the results depicted that mortality significantly associated with DR-TB categorised patients (i.e. TAF, Treatment after Loss to Follow Up and New), both HIV status and Sputum Smear status (i.e. Positive). Nevertheless, among other findings, the binary logistic regression model estimations revealed that categorised New patients and Sputum Smear status unfavourably and significantly predicted the treatment outcome (mortality) of DS-TB and DR-TB patients. As well, categorised Relapse patients unfavourably and significantly predicted the treatment outcome (mortality) of DR-TB patients. Thus, the DS-TB method of treatment is recommended in order to achieve the target goal of the END-TB strategy in Oyo state Nigeria.