Incidence Of MDR-TB Research Articles

Trehalose catalytic shift is an intrinsic factor in Mycobacterium tuberculosis that enhances phenotypic heterogeneity and multidrug resistance.

Drug-resistance (DR) in many bacterial pathogens often arises from the repetitive formation of drug-tolerant bacilli, known as persisters. However, it is unclear whether Mycobacterium tuberculosis (Mtb), the bacterium that causes tuberculosis (TB), undergoes a similar phenotypic transition. Recent metabolomics studies have identified that a change in trehalose metabolism is necessary for Mtb to develop persisters and plays a crucial role in metabolic networks of DR-TB strains. The present study used Mtb mutants lacking the trehalose catalytic shift and showed that the mutants exhibited a significantly lower frequency of the emergence of DR mutants compared to wildtype, due to reduced persister formation. The trehalose catalytic shift enables Mtb persisters to survive under bactericidal antibiotics by increasing metabolic heterogeneity and drug tolerance, ultimately leading to development of DR. Intriguingly, rifampicin (RIF)-resistant bacilli exhibit cross-resistance to a second antibiotic, due to a high trehalose catalytic shift activity. This phenomenon explains how the development of multidrug resistance (MDR) is facilitated by the acquisition of RIF resistance. In this context, the heightened risk of MDR-TB in the lineage 4 HN878 W-Beijing strain can be attributed to its greater trehalose catalytic shift. Genetic and pharmacological inactivation of the trehalose catalytic shift significantly reduced persister formation, subsequently decreasing the incidence of MDR-TB in HN878 W-Beijing strain. Collectively, the trehalose catalytic shift serves as an intrinsic factor of Mtb responsible for persister formation, cross-resistance to multiple antibiotics, and the emergence of MDR-TB. This study aids in the discovery of new TB therapeutics by targeting the trehalose catalytic shift of Mtb.

Hubungan Usia dan Jenis Kelamin dengan TB MDR

Pulmonary tuberculosis is a serious health problem with a fairly high prevalence, including MDR TB. Many factors can affect MDR TB. The purpose of this study was to determine the age and sex with MDR TB. The method in this study is quantitative, using descriptive analytic observational with a cross sectional approach. This research was conducted in the Jasmine Room of Dr. M Yunus Hospital. The sample in the study amounted to 35 respondents who were selected according to the inclusion and exclusion criteria. This study used the chi-square statistical test. The results of this study indicate that most of the respondents 22 (62.9%) suffer from MDR TB, most of the respondents are 17 people (48.6%) in 46 years, more than most of the respondents 20 people (57.1%) are male. - man. The results of the chi-suare test showed that there was a relationship between age and sex with the incidence of MDR TB, with p value <0.05. The conclusion in this study is that age and gender are one of the factors associated with the incidence of MDR TB in the Matahari Room of RSUD dr. M. Yunus Bengkulu.

PRIMARY DRUG RESISTANT TUBERCULOSIS - THE CONCERN!

Tuberculosis is an airborne infection caused by mycobacterium tuberculosis. About 480000 people worldwide developed MDR TB in 2015,additionally 1,00,00 developed resistance to rifampicin and needed MDR TB treatment.MDR TB burden largely falls on China, India & the Russian Federation - which together account for nearly half of the global cases. The proportion of DR-TB cases among new cases is 2-3% and that among previously treated cases is 12-17%. Aims and objectives: To find the incidence of primary MDR TB in a tertiary care center in Navi Mumbai.Materials & Methods: A retrospective study of Culture and sensitivity reports of 100 patients was conducted.All underwent smear examination for AFB by ZNCF method.AFB Gene Xpert (CB-NAAT) and AFB culture and drug sensitivity. Results- In our study we found primary MDR to be 10 % while an additional 1 % was resistant to INH alone. All patients were HIV negative. Conclusion-The high proportion of Primary MDR-TB found in our study compels us to suggest that modalities to diagnose primary drug resistance tuberculosis should be made available to all newly diagnosed TB patients, irrespective of HIV status.

Development of Inhalable ATRA-Loaded PLGA Nanoparticles as Host-Directed Immunotherapy against Tuberculosis.

Developing new effective treatment strategies to overcome the rise in multi-drug resistant tuberculosis cases (MDR-TB) represents a global challenge. A host-directed therapy (HDT), acting on the host immune response rather than Mtb directly, could address these resistance issues. We developed an HDT for targeted TB treatment, using All Trans Retinoic Acid (ATRA)-loaded nanoparticles (NPs) that are suitable for nebulization. Efficacy studies conducted on THP-1 differentiated cells infected with the H37Ra avirulent Mycobacterium tuberculosis (Mtb) strain, have shown a dose-dependent reduction in H37Ra growth as determined by the BACT/ALERT® system. Confocal microscopy images showed efficient and extensive cellular delivery of ATRA-PLGA NPs into THP-1-derived macrophages. A commercially available vibrating mesh nebulizer was used to generate nanoparticle-loaded droplets with a mass median aerodynamic diameter of 2.13 μm as measured by cascade impaction, and a volumetric median diameter of 4.09 μm as measured by laser diffraction. In an adult breathing simulation experiment, 65.1% of the ATRA PLGA-NP dose was inhaled. This targeted inhaled HDT could offer a new adjunctive TB treatment option that could enhance current dosage regimens leading to better patient prognosis and a decreasing incidence of MDR-TB.

The incidence of TB and MDR-TB in pediatrics and therapeutic options: a systematic review

BackgroundTuberculosis (TB) is considered one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent. Multidrug-resistant (MDR) TB can affect people of all age groups, including children (aged 0–15 years). However, very little is known about the extent of this problem in children. This systematic review aims to investigate the incidence of TB and drug-resistant (DR) TB among the pediatric population. It also reviews the therapeutic options available to treat the condition.MethodsA comprehensive search for all relevant evidence was conducted. The following databases were searched: MEDLINE, CINAHL, and Web of Science. The searched time frame was limited from January 1990 to December 2020 with a focus on the incidence of TB and MDR-TB among pediatrics and the therapeutic options available.ResultsA total of 537 articles were obtained via the selected databases. After title and abstract screening, 418 articles were excluded leaving 119 articles. Full-text screening was conducted on 119 articles, excluding a further 110 articles. Thus, 9 articles were subject to quality assessment and included in this review. The 9 articles represented the age group of 0–15 years and included both males and females. All studies included were of retrospective study design.DiscussionThe included studies mentioned a moderate increase in TB cases among pediatrics exacerbated by malnutrition, lack of bacille Calmette-Guérin (BCG) vaccination, and human immunodeficiency virus (HIV) coinfection. MDR-TB prevalence was especially high in South Africa. Drug therapy for both TB and MDR-TB yielded favorable outcomes among pediatrics. However, one of the biggest challenges with drug therapy includes the dosage forms available.Systematic review registrationDOI: 10.17605/OSF.IO/G34NF

RELEVANSI KEPATUHAN PENGOBATAN DENGAN KEJADIAN TB MDR DI RUMAH SAKIT UMUM DAERAH EMBUNG FATIMAH KOTA BATAM TAHUN 2019

MDR TB (multidrug-resistant) is tuberculosis caused by Mycobacterium tuberculosis which has developed immunity to OAT (rifampin and isoniazid). The incidences of MDR TB are an artificial phenomenon (artificial phenomenon) due to inadequate TB treatment. Adherence to TB treatment is a factor that influences the incidence of MDR TB. This study aims to determine the relationship of adherence with the incidence of MDR TB in TB patients with a case-control design. The number of respondents in this study was 20 case respondents and 20 control respondents at Embung Fatimah Hospital, Batam City. The sampling technique used purposive sampling with a non-probability sampling technique. The results of the chi-square test obtained a p-value = 0.004 (< 0.05), then H? is accepted, this indicates that there is a significant relationship between adherence and the incidence of MDR TB in Embung Fatimah Hospital, Batam City in 2019, with an OR value of 7,000 where medication adherence with no category has a seven times greater risk of developing MDR TB. This study concludes that there is a relationship between compliance with the incidence of MDR TB at Embung Fatimah Hospital, Batam City, in 2019. The implication of this study is to identify one of the factors that have a relationship with the incidence of MDR TB to reduce the increase in the incidence of MDR TB.
 Keywords: Relevance, Compliance, MDR TB, OAT, TB

PREVALENCE OF POSITIVITY OF CBNAAT IN PULMONARY TUBERCULOSIS

Background: TB Is the ninth leading cause of death worldwide and the leading cause from a single infectious agent, ranking above HIV/AIDS. In 2016, there were an estimated 1.3 million TB deaths among HIV negative people (down from 1.7 million in 2000) and an additional 374 000 deaths among HIV-positive people.
 Methods: This is a retrospective study conducted in the department of Pulmonary medicine. Early morning sputum sample was collected from the patients in a clean sterile container.
 Results: Among the total 500 samples, 110 were detected tuberculosis positive by CBNAAT method and 390 were negative. And among 110 positive cases, 107 were Rifampicin sensitive and 3 were Rifampicin resistant
 Conclusion: CBNAAT detects pulmonary TB with greater efficacy than sputum microscopy also helping in early diagnosis in less than 2 hours. It also detects rifampicin resistance with high specificity and can be used for screening for MDR-TB so that early therapy can be started thus decreasing the incidence of MDR-TB. WHO recommends CBNAAT for early diagnosis of pulmonary tuberculosis and detection of rifampicin resistance and retreatment cases, who are at risk of MDR-TB.
 Keywords: CBNAAT, MDR, Pulmonary tuberculosis

Tuberculosis Situation in Volga Federal District in 2016-2020

The objective of the study: to assess changes in the incidence and prevalence of multiple drug resistant tuberculosis (MDR TB) and TB/HIV coinfection (TB/HIV) in Volga Federal District (VFD) and its regions during 2016-2020.Subjects and Methods. Data from FGSN Forms No. 8, 33, and 61, and analytical reviews of main statistical TB rates in the Russian Federation have been studied. The number of those died is presented as per the Rosstat data.Results. An increase in the incidence and prevalence of MDR TB and TB/HIV coinfection has been detected in certain region of Volga Federal District. Perm Region, the Republic of Bashkortostan, the Republic of Udmurtia, and Orenburg and Samara Regions have the highest prevalence of MDR TB and TB/HIV coinfection. In 2020, the Republic of Bashkortostan was the only region where the incidence and prevalence of MDR TB were growing (164.7% and 47.3%, respectively). The highest incidence and prevalence of TB/HIV coinfection was reported in the Republic of Bashkortostan, Perm Kray, Orenburg Region, the Chuvash and Udmurt Republics. Over the last 5 years, the maximum increase in TB/HIV incidence and prevalence was observed in the Republic of Bashkortostan (38.8% and 41.3%, respectively).

Prospects for the elimination of tuberculosis in the Northwestern Federal District of Russia

The most prosperous TB situation in Russia is observed in the Central and Northwestern Federal Districts, where there are the greatest chances to be the first in the Rus-sian Federation to achieve the target indicators of the End TB strategy. Since 2018, a set of measures has been implemented under the slogan: «NWFD — a territory free from tuberculosis». The purpose of this study is to study the dynamics of morbidity and mortality from TB in the Northwestern Federal District and the Russian Federation in 2005–2021. The study of morbidity — according to the forms No. 8 and No. 33 of the FSN, mortality — accord-ing to demographic data. Mortality from TB in the NWFD over 15 years decreased by 7.6 times from 19.6 in 2005 to 2.6 per 100,000 in 2020 (in the Russian Federation by 4.8 times from 22.6 to 4.7), on average by 12.5% per year (in the Russian Federation by 9.9%). In recent years, the de-cline in the indicator began to slow down exponentially. If the trend continues, mortality in the NWFD, compared with 2015, may decrease by 83% by 2025 and by 97% by 2035, which corresponds to the End TB target criterion. There is a linear trend towards a decrease in the inci-dence by 3.2 times from 63.2 per 100,000 in 2009 to 19.7 in 2021 (2.7 times in the Russian Federation from 82.6 to 31.1). On average, over 12 years, the indicator in the NWFD decreased linearly by 9.2% per year (in the Russian Federation by 7.7%) to zero by 2026, which is practically unrealistic. In the coming years, we should expect a slow-down in the rate of decline in incidence with a transition to an exponential trend. In 2020, there was an acceler-ation in the decline in the incidence of TB, and in 2021, a worsening of the clinical structure of TB cases due to the COVID-19 epidemic. In recent years, the NWFD has seen a more favorable trend in reducing the incidence of MDR-TB and TB/HIV than the average for the Russian Federa-tion. There is a pronounced trend towards a decrease in the incidence of extrapulmonary tuberculosis, especially genitourinary localization.

Bioprospecting for antituberculosis natural products – A review

Abstract There has been an increase in the reported cases of tuberculosis, a disease caused by Mycobacterium tuberculosis, which is still currently affecting most of the world’s population, especially in resource-limited countries. The search for novel antitubercular chemotherapeutics from underexplored natural sources is therefore of paramount importance. The renewed interest in studies related to natural products, driven partly by the growing incidence of MDR-TB, has increased the prospects of discovering new antitubercular drug leads. This is because most of the currently available chemotherapeutics such as rifampicin and capreomycin used in the treatment of TB were derived from natural products, which are proven to be an abundant source of novel drugs used to treat many diseases. To meet the global need for novel antibiotics from natural sources, various strategies for high-throughput screening have been designed and implemented. This review highlights the current antitubercular drug discovery strategies from natural sources.

Predictors and health-related quality of life with short form-36 for multidrug-resistant tuberculosis patients in Jambi, Indonesia: A case-control study

BackgroundMultidrug-resistant tuberculosis (MDR-TB) is another problem in TB elimination. In 2018, 484,000 people worldwide developed tuberculosis that was resistant to rifampicin, and 78% of those had MDR-TB. Estimation of risk factors to detect MDR-TB. MethodsA case-control study assesses the estimate of the socio-demographic, house environment, diabetes mellitus, treatment behavior, and health-related quality of life (HRQOL). There were 28 cases of MDR-TB patients, and 56 control of drug-susceptible tuberculosis (DS-TB), in the treatment phase of October 1, 2019 to March 31, 2020. ResultsThe analysis showed a diabetes mellitus (adjusted odds ratio [AOR] 4.06, 95% confidence interval [CI] 1.31–12.54), treatment adherence (AOR 3.67, 95% CI 1.26–10.69), and supervisor of drugs swallowing (AOR 3.55, 95% CI 1.06–11.86) as a risk predictor for MDR-TB, and HRQOL independently associated with the incidence of MDR-TB (crude odds ratio [COR] 4.08, 95% CI 1.19–13.98), whereas socio-demographic and house environment was not a risk factor in this study. Validity and reliability of the SF-36 questionnaire (intraclass correlation coefficient [ICC], 0.658–0.802; Cronbach's α coefficient, 0.864). ConclusionDiabetes mellitus, treatment adherence, supervisor of drugs swallowing as a risk predictor for MDR-TB. HRQOL of patients with MDR-TB was lower. The SF-36 questionnaire is valid and reliable to measure the HRQOL for TB/MDR-TB patients.

Gambaran Riwayat Pengobatan Tuberkulosis pada Pasien Multi Drug Resistant Tuberculosis di RSUP Dr. M. Djamil Padang

Background. The incidence of MDR-TB becomes a health issue that must be addressed immediately. According to a 2014 WHO report, the incidence of deaths from MDR-TB reached 190,000 cases. In 2015 there were 250,000 deaths and in 2016 there were 240,000 deaths. The incidence of MDR-TB cases in Indonesia has been reported in 2013 reaching 1,094 cases. In 2014 there were 1,752 cases and in 2015 there were 1,860. MDR-TB events can occur due to failure in the treatment of previous TB.
 Objective. This research aim to know overview of tuberculosis treatment history in patient with multy drug resistant (MDR-TB) in RSUP Dr. M. Djamil Padang
 Methods.This research an descriptive study with cros sectional designed, based on medical record of MDR-TB patient in RSUP Dr. M. Djamil Padang in 2018-2019, a sample of 37 people sample using total sampling and it was analyzed by univariate analysis.
 Result. The result of this research showed the characteristics of MDR-TB were found most in the age group of 35-44 years(27%), male gender (64,9%), self imployed (35,1%). with the most history of treatment in the form of relapsing cases (32,4%).
 Conclusion. the conclusion of this study is the patient with MR-TB in RSUP Dr. M. Djamil Padang dominated by age of 35-44 years old, male and self imployed and the history of TB treatment in MDR-TB patients founnd the most cases of relaps

Anti-Tuberculosis Drugs against the Resistance Level of Mycobacterium tuberculosis isolates

Prolonged MDR-TB therapy can have side effects, namely a correlation between cure rates and changes in bacterial profiles related to resistance to anti-tuberculosis drugs (ATD) which can affect the incidence rate of MTB and MDR-TB in a region. The research objective was to analyze the effectiveness of the type of ATD against the resistance level of Mycobacterium tuberculosis (MTB) isolates with the incidence of tuberculosis (TB) and MDR-TB. The research method used was a retrospective cohort based on tracing medical record data at the Surakarta City Center General Hospital 2016 until 2017 with total sampling. The independent variable of this study was the type of ATD, while the dependent variable was the resistance level of MTB isolates. The characteristics of the most patient respondent suspect TB were male with the level of resistance of MTB isolates to ATD relatively varied. The results of the analysis of different tests showed a p value of 0.000 so that the p value was 0.05, so there was an effect of the type of ATD (Strepttomycin, Isoniazid, Rifampicin and Ethambutol) on the resistance of TB isolates from patients with suspected TB. This is useful to determine the success of TB therapy in terms of mortality and the effectiveness of therapy in TB patients.

Scenario analysis for programmatic tuberculosis control in Bangladesh: a mathematical modelling study

Tuberculosis (TB) is a major public health problem in Bangladesh. Although the National TB control program of Bangladesh is implementing a comprehensive expansion of TB control strategies, logistical challenges exist, and there is significant uncertainty concerning the disease burden. Mathematical modelling of TB is considered one of the most effective ways to understand the dynamics of infection transmission and allows quantification of parameters in different settings, including Bangladesh. In this study, we present a two-strain mathematical modelling framework to explore the dynamics of drug-susceptible (DS) and multidrug-resistant (MDR) TB in Bangladesh. We calibrated the model using DS and MDR-TB annual incidence data from Bangladesh from years 2001 to 2015. Further, we performed a sensitivity analysis of the model parameters and found that the contact rate of both strains had the largest influence on the basic reproduction numbers {text{R}}_{{0{text{s}}}} and {text{R}}_{{0{text{m}}}} of DS and MDR-TB, respectively. Increasingly powerful intervention strategies were developed, with realistic impact and coverage determined with the help of local staff. We simulated for the period from 2020 to 2035. Here, we projected the DS and MDR-TB burden (as measured by the number of incident cases and mortality) under a range of intervention scenarios to determine which of these scenario is the most effective at reducing burden. Of the single-intervention strategies, enhanced case detection is the most effective and prompt in reducing DS and MDR-TB incidence and mortality in Bangladesh and that with GeneXpert testing was also highly effective in decreasing the burden of MDR-TB. Our findings also suggest combining additional interventions simultaneously leads to greater effectiveness, particularly for MDR-TB, which we estimate requires a modest investment to substantially reduce, whereas DS-TB requires a strong sustained investment.

Meta-Analysis: Risk Factors Associated with Multidrugs-Resistant Tuberculosis (MDR-TB) in Tuberculosis Patients

Background: Today, the world not only has to face a higher number of deaths from TB every year, but other challenges arise in the form of drug-resistant TB with risk factors that can affect the incidence of MDR TB, namely treatment-related factors (direct) and other factors (not direct). direct) such as biological, social, economic, and health system factors. The aim of this study was to estimate the risk of HIV infection, smoking and previous medication history on the incidence of MDR TB, with a meta-analysis of primary studies conducted by previous authors. Subjects and Method: This study was conducted using a systematic review and meta-analysis study design using PICO, population: Tuberculosis Patients. Intervention: Risk Factors for HIV Infection, Smoking, and History of Medication. Comparison: no HIV infection, no smoking and no history of medication, Outcome: MDR-TB incidence. The articles used in this study came from 4 databases, namely Pubmed, ScienceDirect, ProQuest and Google scholar. The article keywords are ("Risk factor" or "associated") AND ("Multidrug resistant Tuberculosis" or "MDR TB") AND “Case Control” AND (HIV or Smoke or treatment). The articles included in this study are full paper articles, case-control study designs, 2011-2021 and the size of the relationship between Adj Odds Ratio. Article selection is done using PRISMA. Articles were analyzed using the Review Manager 5.3 application. Results: A total of 20 case-control studies with 18,790 TB patients with details of 4,220 cases and 14,570 controls from 3 America, Africa, and Asia. HIV infection had a risk of 2.05 times in TB patients becoming MDR-TB (aOR = 2.05; 95% CI = 1.03 to 4.07; p= 0.040). Smoking had a 2.2 times risk in TB patients for MDR-TB (aOR= 2.20; 95% CI= 1.87 to 2.59; p<0.001). History of TB treatment had a 9.08 times risk in TB patients to become MDR-TB (aOR=9.08; 95% CI= 5.49 to 15.03; p<0.001). Conclusion: Risk factors for HIV infection, smoking and history of TB treatment increase the incidence of TB to MDR-TB. Keywords: Multidrugs Resistant Tuberculosis, HIV, smoking, TB treatment history Correspondence: Nurul Dwi Andriani. Public Health Science, Faculty of Public Health, Universitas Diponegoro, Central Java, Indonesia. Jl. Prof. Sudarto No.13, Tembalang, Semarang, Central Java. Email: nurul.d.andriani@gmail.com. Mobile: +6282137279586 Journal of Health Promotion and Behavior (2021), 06(03): 233-249 DOI: https://doi.org/10.26911/thejhpb.2021.06.03.07

Evaluation of BAL versus sputum specimen for the diagnosis of pulmonary tuberculosis in sputum AFB smear negative patients- retrospective study at PIMSR, Gujarat

Aims and Objective: Early diagnosis of smear negative tuberculosis is a significant challenge in control of tuberculosis. The present retrospective study was done on sputum and BAL samples of the same patients for better diagnosis of pulmonary tuberculosis. Material and Methods: A total of 1000 (700 sputum and 300 BAL) specimens were processed to rule out tuberculosis in suspected cases during the period of August 2015 to March 2018. The result of sputum as well as BAL specimens from 300 same patients were examined for ZN staining and GeneXpert tests. The samples of sputum and BAL were processed as per the standard guidelines. Results: Total of 1000 specimens (700 sputum & 300 BAL) were considered for the results. Out of 1000 specimens 300 patients had submitted both sputum as well as BAL specimens. These 300 specimens were analyzed for comparative results. Out of 300 common samples, 109 (36.3%) sputum and 136 (45%) BAL samples are positive by ZN stain. Whereas, Out of 300 common samples, 149 (49.6%) sputum and 170 (56.6%) BAL samples are positive by GeneXpert method. Out of 149 common specimens that were positive by GeneXpert, 5(3.3%) were found to be Rifampicin resistant. Conclusion: Incidence of MDR TB is 3.3% in our hospital. BAL was found to be superior specimen to sputum for the diagnosis of ZN smears negative pulmonary TB. Sensitivity and specificity of GeneXpert is higher than AFB smear microscopy. Keywords: Sputum, BAL, GeneXpert, MDR-TB (Multidrug Resistance Tuberculosis).

Evaluation of Knowledge of MDR-TB among Medicine Training Doctors in Tertiary Care Hospital, Karachi, Pakistan

Tuberculosis is the oldest documented infectious diseases in humans and they still cause significant morbidity and mortality. Multi-Drug Resistant Tuberculosis (MDR-TB) is a growing hazard to human health worldwide and threat to control of tuberculosis. WHO estimates 3.2% incidence of MDR TB in new cases. MDR-TB new cases are created each year by a combination of poor patient compliance with treatment and physician error. The purpose of the study is to determine the status of knowledge and awareness amongst the medicine resident about the very basic knowledge of MDR-TB and need to strengthen teaching about tuberculosis to postgraduates so the objective of the study is to determine the frequency of knowledge of MDR –TB among medicine residents (postgraduate trainees) at a tertiary health care hospital Karachi. It is a descriptive based cross sectional study. 58 post graduates trainees were included. A simple questionnaire about MDR-TB was asked to fill in 30 minutes, each correct response will be given 10 marks and those who score 70% will be labeled as knowledgeable. The primary outcome measure was the frequency of knowledge of MDR –TB among medicine residents (postgraduate trainees) at a tertiary health care which turned out to be 65.5% knowledge among postgraduate trainees. So we concluded that there is a need of further studies with larger sample size and follow up studies after educating the trainees more of senior levels so that identification of predictors of mortality, so as to timely diagnose, intervene and hence prevent morbidity and fatalities. It is, therefore, important to develop continuous health education to improve TB knowledge and awareness at different levels.

Relationship of Mutation of Kodon S 315 T katG Mycobaterium Tuberculosis Gene with Multidrug Resistance Tuberculosis in South Sumatera

MDR TB is a condition of M. tuberculosis that is resistant to isoniazid and rifampicin. This occurs because of certain genomic mutations in certain Mtb specific genes. Some of the genes that play a role in the INH mutation are the katG gene, the inhA gene, the ahpC gene, the ndh gene and the kasA gene. The most frequent mutation gene is the katG gene, around 50-80%, and the most mutations (64%) are found in the S 315T codon. The aim was to determine the relationship of S315T genotype in the M. tuberculosis katG gene with the incidence of Mtb resistance in MDR TB patients in South Sumatra. This type of research is an observational cross sectional study approach, conducted in Palembang RSMH in collaboration with the Clinical Microbiology Laboratory of FK UNSRI Palembang from January - July 2019. The sample of the case group (MDR TB) was 50 people while the control group (TB SO) was 21 people. Each group was tested for S315T genotype katG M. tuberculosis gene using the PCR-RFLP method with the Mspl enzyme. Visualization of the katG gene in codon 315 in this study was only found in 40 samples, 26 samples in the case group (MDR TB) and 14 samples in the control group (TB SO). Results Genetic frequency distribution in the case group (MDR TB) was 65.38% wildtype and 34.62% mutant, whereas in the control group (TBSO) it was 92.86% wildtype and 7.14% mutant. The 315 coded KatG gene mutation in this study was not related to the incidence of MDR TB, with p = 0.07, an odds ratio of 6.8 (0.77 - 61.40, 95% CI). The conclusions of this study found 315G katG M. tuberculosis codon mutation mutations of 34.62% but not significantly related to the incidence of MDR TB in South Sumatra.

The novel potential biomarkers for multidrug-resistance tuberculosis using UPLC-Q-TOF-MS.

The lack of rapid and efficient diagnostics impedes largely the epidemic control of multidrug-resistant tuberculosis, and might misguide the therapeutic strategies as well. This study aimed to identify novel multidrug-resistant tuberculosis biomarkers to improve the early intervention, symptomatic treatment and control of the prevalence of multidrug-resistant tuberculosis. The serum small molecule metabolites in healthy controls, patients with drug-susceptible tuberculosis, and patients with multidrug-resistant tuberculosis were screened using ultra-high-performance liquid chromatography combined with quadrupole-time-of-flight mass spectrometry (UPLC-Q-TOF-MS). The differentially abundant metabolites were filtered out through multidimensional statistical analysis and bioinformatics analysis. Compared with drug-susceptible tuberculosis patients and healthy controls, the levels of 13 metabolites in multidrug-resistant tuberculosis patients altered. Among them, the most significant changes were found in N1-Methyl-2-pyridone-5-carboxamide (N1M2P5C), 1-Myristoyl-sn-glycerol-3-phosphocholine (MG3P), Caprylic acid (CA), and D-Xylulose (DX). And a multidrug-resistant tuberculosis/drug-susceptible tuberculosis differential diagnostic model was built based on these four metabolites, achieved the accuracy, sensitivity, and specificity of 0.928, 86.7%, and 86.7%, respectively. The enrichment analysis of metabolic pathways showed that the phospholipid remodeling of cell membranes was active in multidrug-resistant tuberculosis patients. In addition, in patients with tuberculosis, the metabolites of dipalmitoyl phosphatidylcholine (DPPC), a major component of pulmonary surfactant, were down-regulated. N1M2P5C, MG3P, CA, and DX may have the potential to serve as novel multidrug-resistant tuberculosis biomarkers. This research provides a preliminary experimental basis to further investigate potential multidrug-resistant tuberculosis biomarkers. Impact statement The MDR-TB incidence remains high, making the effective control of TB epidemic yet challenging. Rapid and accurate diagnosis is vitally important for improving the therapeutic efficacy and controlling the prevalence of drug resistance TB. Metabolomics has dramatic potential to distinguish MDR-TB and DS-TB. N1M2P5C, MG3P, CA, and DX that we identified in this study might have potential as novel MDR-TB biomarkers. The phospholipid remodeling of cell membranes was highly active in MDR-TB. The DPPC metabolites in TB were significantly down-regulated. This work aimed to investigate potential MDR-TB biomarkers to enhance the clinical diagnostic efficacy. The metabolic pathway distinctly altered in MDR-TB might provide novel targets to develop new anti-TB drugs.

Comparison of induced sputum and bronchial washings for CBNAAT in diagnosing sputum smear negative pulmonary tuberculosis

Introduction: Tuberculosis is one of the most infectious public health problems for decades and has also become difficult to diagnose in recent times due to association with immunocompromised status. With the advent of the newer diagnostic technique like CBNAAT, can providing positive results even in less number of tuberculos bacilli in specimen samples. The present study was aimed to compare induced sputum and bronchial washings for CBNAAT in diagnosing sputum smear negative tuberculosis. Materials and Methods: A prospective, observational study was conducted in the Department of Pulmonary Medicine, Maharaja Institute of Medical Sciences (MIMS), Vizianagaram, Andhra Pradesh, India. A total of 43 patients with sputum negative tuberculosis were enrolled and induced sputum and BAL fluid for CBNAAT sent for analysis under RNTCP in district hospital. Results: Male patients (67.45%) were more compared to the females (32.55%). Majority belongs to 51-60 years with mean age group of 49.18 years. Most common X- ray presentation was infiltration followed by consolidation. Induced sputum CBNAAT was positive in only 07 patients compare d to bronchial washings CBNAAT in 27 patients. Conclusions: As CBNAAT can diagnose rapidly and prevent transmission and mortality in smearnegative in pulmonary tuberculosis patients, all smear-negative and immunocompromised patients should be subjected to CBNAAT. CBNAAT detects pulmonary TB in PLHIV with greater efficacy than sputum microscopy, also helping in early diagnosis in less than 2 hours, so that early therapy can be started, thus decreasing the incidence of MDR-TB and associated its mortality. Keywords: Bronchial washings, CBNAAT, Induced sputum, Pulmonary tuberculosis, Smear negative.