Incidence Of Multidrug-resistant Tuberculosis Research Articles

Spatial Analysis of Drug-Susceptible and Multidrug-Resistant Cases of Tuberculosis, Ho Chi Minh City, Vietnam, 2020-2023.

We characterized the spatial distribution of drug-susceptible (DS) and multidrug-resistant (MDR) tuberculosis (TB) cases in Ho Chi Minh City, Vietnam, a major metropolis in southeastern Asia, and explored demographic and socioeconomic factors associated with local TB burden. Hot spots of DS and MDR TB incidence were observed in the central parts of Ho Chi Minh City, and substantial heterogeneity was observed across wards. Positive spatial autocorrelation was observed for both DS TB and MDR TB. Ward-level TB incidence was associated with HIV prevalence and the male proportion of the population. No ward-level demographic and socioeconomic indicators were associated with MDR TB case count relative to total TB case count. Our findings might inform spatially targeted TB control strategies and provide insights for generating hypotheses about the nature of the relationship between DS and MDR TB in Ho Chi Minh City and the wider southeastern region of Asia.

Association Between Vitamin D Levels With Mdr-Tb Patients With Household Contacts And Healthy People As Comparison

Abstract
 Background: The high incidence of pulmonary tuberculosis (TB) progressing into multidrugresistant TB (MDR-TB) has become a serious concern and caused a high mortality rate. The incidence of MDR-TB was 3.3% of new cases and 20% of cases of recurrent treatment. Low levels of vitamin D is a predisposing factor of MDR-TB, and family members in contact with the patient also show risk of infection. Currently, there is no study that compares vitamin D levels between MDR-TB patients and their household contact.
 Method: This is a case control study, with the number of samples of each group (MDR-TB patients, household contact, healthy controls) 40 subjects, respectively. Each member of each group were checked for vitamin D levels using enzyme-linked immunosorbent assay (ELISA) technique.
 Result: Mean levels of vitamin D in MDR-TB patients are 32.21, contact families 31.7 and healthy controls 26.86. There is a significant relationship between vitamin D levels and MDR-TB incidence (p=0.006).
 Conclusion : There was no significant association between vitamin D deficiency level with MDRTB. Vitamin D insufficiency was a protective factor for MDR-TB than in healthy control.

Role of HIV Infection in Multi-Drug Resistant Tuberculosis in Parts of Benue State, Nigeria

The pathogenesis of Tuberculosis shows that M. tuberculosis target and persist within phagocytes including T-lymphocytes in blood circulation. As a result, the possibility of cellular interaction between M. tuberculosis and HIV, especially for patients that are co-infected with HIV and TB, and subsequent exchange of genetic material via transduction needs to be investigated. Three hundred and eighty sputum samples mostly from suspected rifampicin-resistance patients were collected from Nigerian Airforce (NAF) Hospital Makurdi, and Federal Medical Centre (FMC) Makurdi. In vitro culture of sputum samples, Drugs Susceptibility Testing (DST) of M. tuberculosis isolates, and transduction protocol were carried out at the National Tuberculosis and Leprosy Training Centre (NTBLTC) Zaria, Nigeria. Statistical analysis was carried out using Student’s t-test. Minitab version 14.0 statistical software was used for data analysis. P-values < 0.05 were considered significant. Twenty-six (9.7%) cases of Multi-drug resistant tuberculosis (MDR-TB) were detected (retreated cases 7.1%; treatment naive 2.6%). Twenty-one (80.8%) were males and 5(19.2%) were females. There was statistical difference in MDR-TB between male and female in Benue State (P<0.05). The mean age group 35-45 years had the highest cases of MDR-TB accounting for 35% of MDR-TB. Human-immunodeficiency virus and Tuberculosis co-infected patients (category I) had the highest MDR-TB incidence of 10(38.5%). There was no significant difference between category-1 and category-III [patient with only TB disease (P>0.05)]. However, there were elevated cases of MDR-TB in category-III patients from 7(26.9%) to 10(38.5%) following transduction protocol. Multi-drugs resistant tuberculosis is prevalent in Benue State, affecting the most economically active youths within the age group of 35-45 years, as a result the need to direct more attention on molecular basis for M. tuberculosis drugs resistance is therefore advocated, in order to win the war against multi-drug resistant tuberculosis.

Risk Factor Identification of Multi-Drug Resistant Tuberculosis

Background: Multi-drug resistant tuberculosis (MDR-TB) is a serious health problem with high morbidity and mortality. The identification of risk factors is needed to prevent the incidence TB-MDR. Objective: To identify the risk factors of TB-MDR in the Special Region of Yogyakarta.Method: This study used a case control design to assess the risk factors for the incidence of MDR-TB. Patients diagnosed with MDR-TB compared to non-MDR TB patients were then compared to exposure to the risk factors studied. The results of the study were analyzed by calculating the mean and proportion. Next, Chi-square tests and analysis of odds ratio (OR) with 95% confidence interval (CI) were conducted using a 2x2 dummy table as an aid with multivariate logistic regression analysis.Result: There were 53 patients with MDR-TB as the case group and 106 non-MDR TB patients as controls. There were no significant differences between the two groups regarding the characteristics of age, sex, place of residence, and type of work (p>0.05). The multivariate analysis found the risk factors associated with an increased incidence of MDR-TB were a history of previous TB treatment (p<0.001; OR 31.82; 95%CI: 9.40-107.77) and surrounding TB (p<0.01; OR 4.45; 95%CI: 1.45-13.70), while other factors that were not significantly related to the incidence of MDR-TB included body mass index, distance of home to health facilities where taking medicine, smoking, drinking alcohol, history of BCG vaccination, education, income, medication adherence, and comorbidities (p> 0.05).Conclusion: The risk factors found to be associated with an increased incidence of MDR-TB in this study were the presence of surrounding TB patients and a history of previous TB treatment.

Phylogeography and transmission of M. tuberculosis in Moldova: A prospective genomic analysis.

The incidence of multidrug-resistant tuberculosis (MDR-TB) remains critically high in countries of the former Soviet Union, where >20% of new cases and >50% of previously treated cases have resistance to rifampin and isoniazid. Transmission of resistant strains, as opposed to resistance selected through inadequate treatment of drug-susceptible tuberculosis (TB), is the main driver of incident MDR-TB in these countries. We conducted a prospective, genomic analysis of all culture-positive TB cases diagnosed in 2018 and 2019 in the Republic of Moldova. We used phylogenetic methods to identify putative transmission clusters; spatial and demographic data were analyzed to further describe local transmission of Mycobacterium tuberculosis. Of 2,236 participants, 779 (36%) had MDR-TB, of whom 386 (50%) had never been treated previously for TB. Moreover, 92% of multidrug-resistant M. tuberculosis strains belonged to putative transmission clusters. Phylogenetic reconstruction identified 3 large clades that were comprised nearly uniformly of MDR-TB: 2 of these clades were of Beijing lineage, and 1 of Ural lineage, and each had additional distinct clade-specific second-line drug resistance mutations and geographic distributions. Spatial and temporal proximity between pairs of cases within a cluster was associated with greater genomic similarity. Our study lasted for only 2 years, a relatively short duration compared with the natural history of TB, and, thus, the ability to infer the full extent of transmission is limited. The MDR-TB epidemic in Moldova is associated with the local transmission of multiple M. tuberculosis strains, including distinct clades of highly drug-resistant M. tuberculosis with varying geographic distributions and drug resistance profiles. This study demonstrates the role of comprehensive genomic surveillance for understanding the transmission of M. tuberculosis and highlights the urgency of interventions to interrupt transmission of highly drug-resistant M. tuberculosis.

Screening and identification of differentially expressed long non-coding RNAs in multidrug-resistant tuberculosis.

BackgroundEfforts to eradicate tuberculosis are largely threatened by drug-resistant tuberculosis, particularly, multidrug-resistant tuberculosis (MDR-TB). Screening and identification potential biomarkers for MDR-TB is crucial to diagnose early and reduce the incidence of MDR-TB.MethodsTo screen the differentially expressed long non-coding RNAs in MDR-TB, the lncRNA and mRNA expression profiles in serum derived from healthy controls (HCs), individuals with MDR-TB and drug-sensitive tuberculosis (DS-TB) were analyzed by microarray assay and 10 lncRNAs were randomly selected for further validation by reverse transcription-quantitative real-time PCR(RT-qPCR). The biological functions of differentially expressed mRNAs as well as relationships between genes and signaling pathways were investigated using Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG), respectively.ResultsA total of 353 differentially expressed lncRNAs (312 upregulated) and 202 mRNAs (99 upregulated) were found in the MDR-TB group compared to HCs. And compared with the DS-TB group, 442 differentially expressed lncRNAs (115 upregulated) and 190 mRNAs (87 upregulated) were found in the MDR-TB group. The expression levels of lncRNA n335659 were found to differ significantly between each group by RT-qPCR. Compared with DS-TB group, the GO analysis showed that the differential mRNAs were mainly enriched in the processes associated with the detection of the chemical stimulus, the regulation of mRNA metabolic process and neutrophil activation in the MDR-TB group; the KEGG analysis indicated that the differential mRNAs between DS-TB and MDR-TB were mainly enriched in proteasome and Notch signaling pathway, which might reveal a fraction of the mechanism of MDR-TB. The discovery of the serum lncRNA n335659 might serve as a potential biomarker for MDR-TB and Notch signaling pathway provided a new clue for the investigation of the pathological mechanism of MDR-TB.

Survival Status and Predictors of Mortality among Multidrug-Resistant Tuberculosis Patients in Saint Peter's Specialized Hospital, Addis Ababa, Ethiopia.

Background Multidrug-Resistant Tuberculosis (MDR-TB) is tuberculosis that is resistant to at least both rifampicin and isoniazid. The World Health Organization as reported in 2019 revealed that Ethiopia is among the 20 countries with the highest estimated numbers of incident MDR-TB cases. However, supporting evidence is limited in the study area after the Ethiopian national strategic plan for tuberculosis prevention and control is started. Objective To determine survival status and predictors of mortality among multidrug-resistant tuberculosis patients treated in Saint Peter's Specialized Hospital at Addis Ababa, Ethiopia, 2020. Methods An institutional retrospective cohort study was conducted using all MDR-TB patients who were enrolled in Saint. Peter's Specialized Hospital from January 01, 2015, to December 31, 2017. A pretested data extraction form that had 5 items for sociodemographic and 15 items for the measurement of clinical characteristics of 484 MDR-TB patients was used. STATA software version 14.2 was used for data cleaning and analysis. A variable that fitted in the bivariable Cox proportional hazard model at p value <0.25 was used in the final multivariable Cox proportional hazard model, and independent predictors of time to event were determined at a p value of 0.05. Result A total of 484 patients were followed up for 5,078 person-months. Among the total patients, nearly half, 238 (48.8%), were males. The median age of patients was 30 years (interquartile range (IQR), 24–39), and 56 (11.6%) were aged between 1 and 19 years. During the follow-up period, 315 (65.1%) patients were cured, 125 (25.8%) completed treatment, 24 (5%) died, and 20 (4.1%) were lost to follow-up. The overall cumulative probability survival of the patients at the end of treatment was 94.85% (95% confidence interval (CI): 92.38%–96.53%). The independent predictors of time to death were being anemic (AHR = 3.65; 95% CI: 1.36, 9.79), having clinical complication (AHR = 3; 95% CI: 1.2, 7.5), and being HIV infected (AHR = 5.8; 95% CI: 2.2, 15.7). Conclusions MDR-TB patients' survival rate was high in St Peter's Specialized Hospital. MDR-TB patients with anemia, HIV coinfection, and clinical complications had higher risk of mortality. So, prevention and controlling of anemia, HIV/AIDS, and clinical complications will reduce the mortality of MDR-TB patients.

Epidemiological analysis of factors influencing the course of multidrug-resistant tuberculosis in HIV-infected patients with concomitant viral hepatitis

The epidemiological significance of combined forms of especially dangerous infections has not been studied enough, unlike mono-infections. Currently, there is a tendency towards an increase in the incidence of multidrug-resistant tuberculosis. The formation of severe forms of the disease is caused by other widespread infections, such as chronic viral hepatitis and HIV. Polymorbid conditions distort the clinical manifestations of tuberculosis, reduce the effectiveness of anti-tuberculosis therapy and worsen the prognosis of the disease. Risk factors among patients in this category need analysis to carefully monitor patients and ensure infection control. Objective is to analyze the factors affecting the course of multidrug-resistant tuberculosis in HIV-infected patients with concomitant viral hepatitis. Materials and methods. Cases of the combined pathology of multiresistant tuberculosis, HIV infection and viral hepatitis with a dominant diagnosis of tuberculosis are analyzed. Results and discussion. The influence of the immunological status on the course of combined pathology was revealed. Since all the patients under study had clinical stage 4 of HIV infection, tuberculosis developed as an opportunistic infection. Severe immunosuppression (CD4 200 cells/ml) contributed to the progression of the generalized tuberculosis process. Long-term immunodeficiency was an unfavorable factor; in the overwhelming majority of cases, antiretroviral therapy was prescribed only after tuberculosis was detected. The dependence of the clinical form of tuberculosis on the level of CD4-lymphocytes was noted: isolated lesion of the chest organs prevailed in patients with a level of CD4-lymphocytes more than 200 cells/ml, generalization of TB process — with CD4 less than 200 cells/ml. Patients with miliary tuberculosis had a higher mortality rate compared to patients with other clinical forms, regardless of antiretroviral therapy. It was revealed that socially disoriented young people with viral hepatitis C prevailed in the structure of patients, the prevalence of which was due to the influence of aggravating factors, such as alcohol and drug abuse, and stay in prisons. Against the background of combined treatment, there was no significant effect of viral hepatitis on the course of polymorbid conditions and the effectiveness of the therapy.

Comparative study of different methods of microscopy followed by a culture method in the detection of mycobacterium tuberculosis in clinically and radiologically suspected cases of pulmonary tuberculosis

To compare the sensitivity of 2 microscopic methods for the diagnosis of Mycobacterium tuberculosis (M.tb) along with culture and drug susceptibility testing to first line drugs.: The cross-sectional study comprises 200 suspected cases of pulmonary tuberculosis both clinically and radiologically in KIMS, Bangalore over a period of 2 years. Samples (sputum/BAL fluid) were collected, processed and stained by Ziehl Neelson (ZN) and Fluorescent methods. Culture and drug susceptibilty testing was done for Streptomycin, Isoniazid, Rifampicin and Ethambutol by Mycobacterium growth indicator tube (MGIT) method after decontamination.Fischer’s test : 1. Out of 200 samples: 1.120 were male and 80 were female; 2. 18 were positive by Ziehl Neelson, 21 by Fluorescent and 28 by culture; 3. Majority of the patients belonged to age group 41-50 years (23%); 4. InMGIT, 26 were M.tb and 2 were Non-tubercular mycobacteria; 5. Out of 26 M.tb isolates, 4 were resistant to streptomycin, 6 to isoniazid, 2 to rifampicin and 9 to ethambutol.1. The sensitivity of Fluorescent staining (64.28%) is higher than that of Ziehl-Neelson (51.7%); 2. In MGIT, 26 were M.tb and 2 were Non tubercular mycobacteria; 3. 2 were Multi-drug resistant- tuberculosis (MDR-TB) This study made us aware of the need for prompt detection, identification and appropriate treatment of Tuberculosis due to the rising incidence of MDR-TB.

Incidence Density and Predictors of Multidrug-Resistant Tuberculosis Among Individuals With Previous Tuberculosis History: A 15-Year Retrospective Cohort Study.

Background: To date, too little attention has been paid to monitoring and estimating the risk of incident multidrug-resistant tuberculosis (MDR-TB) among individuals with a previous tuberculosis history (PTBH). The purpose of this study was to assess the incidence of and risk factors for MDR-TB in those individuals.Methods: Between 2005 and 2020, a large, retrospective, population-based cohort study was performed in Hangzhou, China. A multivariable Cox regression model was used to evaluate independent predictors of incident MDR-TB among individuals with PTBH.Results: The incidence density of MDR-TB was 22.6 per 1,000 person-years (95% confidence level and an interval of 20.9–24.3) for individuals with PTBH. The incidence of MDR-TB increased significantly in individuals who• were under 60 years old.• were male.• had a history of direct contact.• came from low-income families.• worked in high-risk occupations.• lived in rural areas.• had a retreatment TB history.• had an unfavorable outcome in their previous treatment (P < 0.05).In addition, we found that the following factors were significantly linked to the MDR-TB risk among individuals with PTBH (P < 0.05):• sociodemographic factors such as the 21–30 and 31–40 year age groups, or a history of direct contact.• clinical factors like passive modes of TB case finding (PMTCF), human immunodeficiency virus infection, unfavorable treatment outcomes, retreated TB history, non-standardized treatment regimens of retreatment TB patients, and duration of pulmonary cavities (DPC).• microbiological factors, such as duration of positive sputum culture.We also found that the 21–30 year age group, low family income, and PMTCF were significantly linked to incident MDR-TB only in males with PTBH, whilst the 41–50 year age group, extended treatment course, and DPC were significantly associated with female MDR-TB only.Conclusion: The incidence of MDR-TB was high, with a higher rate among subjects with a history of direct contact and unfavorable treatment outcomes. There was a gender difference in the incidence density and risk factors of MDR-TB among individuals with PTBH. Long-term monitoring and gender-specific risk-factor modifications should be given to individuals with PTBH.

Modeling Time to Death of Patients with Multidrug-Resistant Tuberculosis at Saint Peter's Specialized Hospital.

Background: Currently, the worldwide prevalence and incidence of multidrug-resistant tuberculosis (MDR-TB) is drastically increasing. The main objective of this study was modeling the time-to-death of patients with MDR-TB at St. Peter’s Specialized Hospital, Addis Ababa, Ethiopia, by using various parametric shared frailty models. Study Design: A retrospective study design was used. Methods: The study population was TB patients with MDR at St. Peter’s Specialized Hospital from January 2016 through December 2019. Exponential, Weibull, and log-normal were used as baseline hazard functions with the gamma and inverse Gaussian frailty distributions. All the models were compared based on Akaike’s Information Criteria. Results: The overall median time to death was 11 months and 123 (33.5%) patients died. Patients who lived in rural areas had shorter survival time than those who lived in urban areas with an accelerated factor of 0.135 (P=0.002). Patients with a history of anti-TB drug consumption had a short survival time than those without such a history with an accelerated factor of 0.02 (P=0.001). The variability (heterogeneity) of time to death of patients in the region for the selected model (Weibull-inverse Gaussian shared frailty model) was θ=0.144 (P=0.027). Conclusion: The MDR-TB patients with weight gain, khat and alcohol consumption, clinical complication of pneumothorax and pneumonia, extrapulmonary TB, and history of anti-TB drug consumption as well as those who lived in rural areas had a shorter survival time, compared to others. There was a significant heterogeneity effect in the St. Peter’s Specialized Hospital. The best model for predicting the time to death of MDR-TB patients was Weibull-inverse Gaussian shared frailty model.

Modeling Time to Death of Patients with Multidrug-Resistant Tuberculosis at Saint Peter's Specialized Hospital.

Background: Currently, the worldwide prevalence and incidence of multidrug-resistant tuberculosis (MDR-TB) is drastically increasing. The main objective of this study was modeling the time-to-death of patients with MDR-TB at St. Peter’s Specialized Hospital, Addis Ababa, Ethiopia, by using various parametric shared frailty models. Study Design: A retrospective study design was used. Methods: The study population was TB patients with MDR at St. Peter’s Specialized Hospital from January 2016 through December 2019. Exponential, Weibull, and log-normal were used as baseline hazard functions with the gamma and inverse Gaussian frailty distributions. All the models were compared based on Akaike’s Information Criteria. Results: The overall median time to death was 11 months and 123 (33.5%) patients died. Patients who lived in rural areas had shorter survival time than those who lived in urban areas with an accelerated factor of 0.135 ( P =0.002). Patients with a history of anti-TB drug consumption had a short survival time than those without such a history with an accelerated factor of 0.02 ( P =0.001). The variability (heterogeneity) of time to death of patients in the region for the selected model (Weibull-inverse Gaussian shared frailty model) was =0.144 ( P =0.027). Conclusion: The MDR-TB patients with weight gain, khat and alcohol consumption, clinical complication of pneumothorax and pneumonia, extrapulmonary TB, and history of anti-TB drug consumption as well as those who lived in rural areas had a shorter survival time, compared to others. There was a significant heterogeneity effect in the St. Peter’s Specialized Hospital. The best model for predicting the time to death of MDR-TB patients was Weibull-inverse Gaussian shared frailty model.

The structural analysis of government expenditures on the purchase of antituberculous drugs

The aim. To conduct a structural analysis of the volume of government spending on the purchase of antituberculosis drugs (anti-TB D) within 2014–2018.&#x0D; Materials and methods. In the study, we used information on public procurement of anti-TB D for 2014–2018 presented on the website of the Ministry of Health of Ukraine in the section “Procurement of Medicines”, as well as statistical data of the “Center for Public Health of the Ministry of Health of Ukraine” on the incidence of multi-drug resistant tuberculosis (MDR-TB) in the population.&#x0D; Analytical and comparative, system, and logical methods, as well as economic analysis were used. With the help of synthesis the conclusions and recommendations were formed.&#x0D; Results. It was found that in 2014-2018, the MDR-TB incidence rate increase had a positive dynamics in reducing the number of registered cases. For example, in 2015 this indicator was 2.56 %, and in 2018 it was -7.93 %.&#x0D; It was proven that public procurement of anti-TB D in physical terms was chaotic. Thus, in 2015/2014, the growth rate of anti-TB D number was 35.55 %, in 2016/2015 – -31.59 %, in 2017/2016 – 15.31 %, in 2018/2017 – 6.13 %. It was found that the dynamics of the growth rate of purchases of TB D in the national currency and USD had some differences. For example, in 2015, expenses increased by 55.02 % in the national currency, while in dollar terms this indicator decreased by 15.64 % compared to 2014. At the same time, in 2018 there was a positive trend of increasing the volume of public spending in monetary terms. Thus, in 2018, the growth rate in the national currency was 53.16 %, and in USD – 49.83 %.&#x0D; It was found that in the structure of public spending there was a tendency for an insignificant predominance of foreign anti-TB D. Based on the comparative analysis of government spending on groups of anti-TB D by the priority of their use in treatment regimens according to the standards it was determined that the process of anti-TB D purchasing did not meet the priority criteria for treatment. It complicates the implementation of the process of reforming TB care in connection with the construction of an outpatient model.

Parameter Estimation of Multivariate Adaptive Regression Spline (MARS) with Stepwise Approach to Multi Drug-Resistant Tuberculosis (MDR-TB) Modeling in Lamongan Regency

Tuberculosis (TB) is an infectious disease, caused by mycobacterium tuberculosis that affects various organs, especially the lungs. If TB treatment is not done thoroughly by the patient, then it can lead to death. Tuberculosis disease could not be healed cause TB bacteria to double immunity against anti-TB drugs, called multi-drug resistant (MDR). One identification issue toward TB infection chain is a TB case distribution analysis using mathematical modeling. The method used in this study was Multivariate Adaptive Regression Spline (MARS). Multivariate Adaptive Regression Spline is one type of non-parametric regression techniques, where the model does not assume the functional relationship between response and predictor variables, and has a flexible functional structure as well. Modeling aims to determine the factors that have the most significant influence on MDR-TB cases in Lamongan regency, as well as predict the incidence of MDR-TB in each sub-regency. The results show, the best model has a combination of BF = 28, MI = 2 and MO = 3, based on the minimum GCV, which is 5.26E-06. Furthermore, the model is statistically proper according to the criteria of APER and Press’s Q.

Protocol for a case–control study of vitamin D status, adult multidrug-resistant tuberculosis disease and tuberculosis infection in Mumbai, India

IntroductionVitamin D status may be an important determinant of multidrug-resistant tuberculosis (MDR-TB) infection, progression to disease and treatment outcomes. Novel and potentially cost-effective therapies such as vitamin D supplementation are...

Model Tatalaksana Komprehensif Tuberculosis Multidrug-Resistant (TB-MDR) Melalui Pendekatan Provider Pelayanan Kesehatan

Introduction: Tuberculosis is a highly contagious disease and requires long-term treatment and large amounts of medication. This can affect the high risk of Multidrug-Resistant Tuberculosis (MDR-TB). A health service approach in providing comprehensive management including promotive, preventive, curative, and rehabilitative is very necessary to overcome these cases. Aim of study: This article aims to determine interventions that can be carried out by health services in preventing the occurrence of multidrug-resistant tuberculosis (MDR-TB). Method: The method used is a literature review through national to international journals that examine the interventions that can be carried out by health services in preventing MDR-TB. The articles or data sources that have been obtained will be compared with one another so that the factors that most influence the occurrence of MDR-TB can be found. Results and Discussion: The literature search results show that health workers, especially doctors, have an important role in managing MDR-TB cases. Management of MDR-TB in a comprehensive manner is carried out through promotive, preventive, curative, and rehabilitative programs through a health service provider approach. Educational activities regarding TB, MDR-TB, or the possibility of drug resistance are important to do to prevent new cases of MDR-TB. Curative treatment is carried out to improve mental and social health. Furthermore, rehabilitative efforts are carried out as a means to improve health status recovery for MDR-TB sufferers. Conclusion: Health service providers can improve facilities, they can carry out promotive, curative rehabilitative management to reduce the incidence of MDR-TB.

Multidrug-resistant Mycobacterium tuberculosis: a report of cosmopolitan microbial migration and an analysis of best management practices

BackgroundTuberculosis (TB) control is a primary global health priority but the goal to eliminate TB is being threatened by the increase in incidence of multidrug-resistant tuberculosis (MDR-TB). With this series of seven MDR-TB cases in migrant patients with identical Mycobacterium tuberculosis strains we aim to illustrate the challenges encountered during therapy and follow-up: language barriers, access to care for migrant patients, depression due to isolation, adverse reactions to the treatment, management of pediatric TB, further contact tracing. We also discuss best practices for the management of complex MDR-TB cases in settings with low overall TB incidence focusing on modern diagnostic assays and an individualized and an interdisciplinary therapeutic approach.MethodsWe describe a case series of seven consecutively diagnosed MDR-TB patients, six of them treated at our tertiary care hospital between May 2018 and March 2020. Epidemiologic data was gained by semi-structured patient interviews and reconstruction of the migration route. The origin of the cluster was confirmed by genotyping of the TB-strains.ResultsSix related patients were diagnosed with pulmonary MDR-TB between May and August 2018. All had a positive Interferon-Gamma-Release Assay (IGRA), in five patients sputum microscopy was positive for acid-fast bacilli (AFB). The genetic and phenotypical drug susceptibility test did not match with MDR-TB strains from an East-African origin. The index patient was identified through genetical fingerprinting. By changing the therapy to a modern MDR-TB regime and using an interdisciplinary and culture-sensitive approach, all patients improved clinically and radiologically.ConclusionHuman migration plays an important role for the global spread of MDR-TB in low incidence countries. Early case detection and adequate treatment are key to prevention of outbreaks. Especially language barriers and complex migration routes make genotyping of TB-strains a crucial tool to identify cases clusters, the potential index patient and transmission dynamics. We are fortunate enough to experience times in which new TB-antibiotics were made available and in which molecular assays revolutionized TB-diagnostics. We need to take advantage of that and develop personalized therapies for patients suffering from drug resistant TB.

Nomogram for individualized prediction of incident multidrug-resistant tuberculosis after completing pulmonary tuberculosis treatment

The purposes of this study were to construct a comprehensive nomogram for providing a simple, precise and personalized prediction of incident multidrug-resistant tuberculosis (MDR-TB) after completing pulmonary tuberculosis treatment (CPTBT). A matched case–control study (1:2 ratios) was performed between 2005 and 2018. A multivariable Cox regression analysis was used to evaluate independent predictors of incident MDR-TB after the CPTBT. A comprehensive nomogram was developed based on the multivariable Cox model. Overall, 1, 836 participants were included in this study. We developed and validated a simple-to-use nomogram that predicted the individualized risk of incident MDR-TB by using 10 parameters after the CPTBT. The concordance index of this nomogram was 0.833 [95% confidence interval (CI) 0.807–0.859] and 0.871 (95% CI 0.773–0.969) for the training and validation sets, respectively, which indicated adequate discriminatory power. The calibration curves for the risk of incident MDR-TB showed an optimal agreement between nomogram prediction and actual observation in the training and validation sets, respectively. The high sensitivity and specificity of nomogram was indicated by using a receiver operating characteristic curve analysis. Through this clinic tool, TB control executives could more precisely monitor, estimate and intervene the risk of incident MDR-TB among individuals with CPTBT.

Multidrug resistance in tubercular mediastinal adenopathy diagnosed by endobronchial ultrasound-transbronchial needle aspiration.

Background:Drug resistance in tuberculosis (TB) is a major public health problem. It is easy to assess for drug resistance in pulmonary samples, but the resistance pattern of TB in the mediastinal nodes has not been studied. The aim of this study is to assess the incidence of multidrug resistance in tubercular mediastinal adenopathy with the help of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration.Materials and Methods:This was a prospective study at a tertiary care teaching hospital in New Delhi where 102 patients with positive mycobacterial cultures from mediastinal lymph node aspirates taken with the help of EBUS were enrolled over 24 months and their drug sensitivity to the first-line antitubercular drugs analyzed.Results:There were 30 cases of drug resistance of 102 culture-positive cases. Of them, 8 patients had multidrug resistant TB (MDR-TB), 16 cases had only single drug resistance, and the remaining 6 cases had more than one drug resistance pattern but not MDR. In our study, the overall incidence of MDR-TB is 7.8% (8/102), although the incidence of MDR-TB in new and re-treatment cases is 2.2% (2/89) and 46.1% (6/13), respectively.Conclusion:Such a high percentage of drug-resistant patients is common in tertiary care hospitals; however, similar percentages may be found in other settings as well. Therefore, all efforts should be made to take samples for Mycobacterium tuberculosis culture from the involved nodes before commencing therapy to avoid treatment failures.

The Effect of Non-Compliance with Medication on Multidrug Resistant of Tuberculosis

Background: Resistant Tubercu­losis (MDR-TB) is the biggest problem in the prevention and eradication of in the world. MDR exists in 27 countries where there are at least 6,800 MDR cases every year and 12% of new cases registered are MDR TB. MDR-TB is a disease caused by resistant Myco­bacterium This study aims to exa­mine the effect of non-compliance with taking medication on the incidence of multidrug resistant tuberculosis (MDR TB). Subjects and Method: The problems of this study with PICO are as follows: Population= patients, Intervention = Non-compliance with taking medication. Comparison= Adherence to taking medication, and Outcome= Incidence of Resistant Tuberculosis. Meta- analy­sis was carried out by systematically reviewing articles from Google Scholar, Pubmed and Springer Link. The articles used in this research are articles that have been published from 2010-2019. The keywords to look for articles are as follows: Risk Factor MDR TB OR Pre­vious Treatment AND Multidrug resistant tuberculosis. The inclusion criteria used were full paper, used English, case control study design and the results reported were adjusted odds ratio. Articles were collected using the PRISMA diagram and analyzed using the Review Manager 5.3 application with a fixed effect model. Results: A total of nine articles reviewed in this study came from Bangladesh, Malaysia, Pakistan and Ethiopia. This resulted in a study showing that the effect of incomplete treatment increased the risk of multidrug resistant tuber­culosis (aOR= 10.04; 95% CI= 8.90 to 11.32; p <0.001). Conclusion: The effect of incomplete treat­ment increases the risk of multidrug resistant tuberculosis in Taiwan, Bangladesh, Malaysia and Ethiopia. Keyword s : Effect of incomplete treatment, resistant tuberculosis (MDR TB) Correspondence: Widya Kurnianingsih. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57125, Central Java. Email: widyakurnianingsih08@gmail.com. Mo­bile: 081556837033. Journal of Epidemiology and Public Health (2020), 05(04): 393-401 https://doi.org/10.26911/jepublichealth.2020.05.04.06