Line Anti-tuberculous Drugs Research Articles

Epidemiology and antimicrobial resistance of Mycobacterium spp. in the United Arab Emirates: a retrospective analysis of 12 years of national antimicrobial resistance surveillance data.

The Eastern Mediterranean Regional Office (EMRO) region accounts for almost 8% of all global Mycobacterium tuberculosis (TB) cases, with TB incidence rates ranging from 1 per 100,000 per year in the United Arab Emirates (UAE) to 204 per 100,000 in Djibouti. The national surveillance data from the Middle East and North Africa (MENA) region on the epidemiology and antimicrobial resistance trends of TB, including MDR-TB remains scarce. A retrospective 12-year analysis of N = 8,086 non-duplicate diagnostic Mycobacterium tuberculosis complex (MTB complex) isolates from the UAE was conducted. Data were generated through routine patient care during the 2010-2021 years, collected by trained personnel and reported by participating surveillance sites to the UAE National Antimicrobial Resistance (AMR) Surveillance program. Data analysis was conducted with WHONET, a windows-based microbiology laboratory database management software developed by the World Health Organization Collaborating Center for Surveillance of Antimicrobial Resistance, Boston, United States (https://whonet.org/). A total of 8,086 MTB-complex isolates were analyzed. MTB-complex was primarily isolated from respiratory samples (sputum 80.1%, broncho-alveolar lavage 4.6%, pleural fluid 4.1%). Inpatients accounted for 63.2%, including 1.3% from ICU. Nationality was known for 84.3% of patients, including 3.8% Emiratis. Of UAE non-nationals, 80.5% were from 110 countries, most of which were Asian countries. India accounted for 20.8%, Pakistan 13.6%, Philippines 12.7%, and Bangladesh 7.8%. Rifampicin-resistant MTB-complex isolates (RR-TB) were found in 2.8% of the isolates, resistance to isoniazid, streptomycin, pyrazinamide, and ethambutol, was 8.9, 6.9, 3.4 and 0.4%, respectively. A slightly increasing trend of resistance among MTB-complex was observed for rifampicin from 2.5% (2010) to 2.8% (2021). Infections due to MTB-complex are relatively uncommon in the United Arab Emirates compared to other countries in the MENA region. Most TB patients in the UAE are of Asian origin, mainly from countries with a high prevalence of TB. Resistance to first line anti-tuberculous drugs is generally low, however increasing trends for MDR-TB mainly rifampicin linked resistance is a major concern. MDR-TB was not associated with a higher mortality, admission to ICU, or increased length of hospitalization as compared to non-MDR-TB.

Vitamin D as Supplementary Treatment for Newly Diagnosed Pulmonary Tuberculosis patients

Objective: To compare vitamin D with placebo in patients with pulmonary tuberculosis in terms of clinical improvement and sputum conversion. Materials And Methods: This is a prospective randomized, double blind, placebo controlled comparative study conducted for a period of 12 weeks in a tertiary care centre in south India. Total Subjects were 60 new cases of pulmonary tuberculosis who are getting TB treatment initiation, Subjects were randomly allocated into two groups, group A and group B comprising of 30 patients in each group. Group A received vitamin D and group B received placebo. Dosage of vitamin D was 0.25mg/day, given in initial six weeks of antituberculosis drug therapy. Serum level of 25-hydroxyvitamin D was measured at time of diagnosis and at 8 weeks of anti-tuberculous therapy. Measurements of haemoglobin, leukocyte count and serum calcium were done at beginning and repeated at 6th, 8th and 12 weeks. Acid fast bacilli were examined at beginning and on 6th, 8thand 12 weeks. Primary outcome was evaluation of conversion time of sputum smear; secondary outcome was clinical improvement as assessed by TB score. Results: There is no significant difference in mean values of age, haemoglobin level, calcium level,serum Vitamin D, TB score and total lymphocyte count in both groups at start of study.There was no statistical difference in serum calcium level, haemoglobin level and total lymphocyte level at end of study. Mean serum vitamin D level at 8th week of treatment was 27.83±7.09ng/dl in group A and 18.83±2.27 in group B, there was statistically significant difference between two groups. Sixth week sputum conversion in 30 subjects of vitamin D group is 100% and in placebo group, it is 76.7%, which was statistically significant. Conclusion: Supplementary vitamin D when added to first line anti-tuberculous drugs results in shorter conversion time and less severe TB clinical manifestation without any manifestations of hypercalcemia. Therefore, it is recommended to add vitamin D as supplementary treatment to first-line anti-tuberculous drugs in treatment course of active pulmonary TB.

Emerging threat of drug-resistant tuberculosis and trends in the era of COVID-19: A descriptive study from northwestern Nigeria

BackgroundMycobacterium tuberculosis with resistance to first line and second line anti tuberculous drugs is a serious setback in the treatment of tuberculosis (TB). The COVID-19 pandemic constitutes a serious threat that could unwind the recent gains made thus far in the control of tuberculosis. This study aims to explore the pattern of drug resistant tuberculosis (DRTB) in our institution. We also aimed to explore the changing trends of TB in the era of the COVID-19 pandemic. MethodsThis descriptive study included all DRTB patients admitted and managed in the hospital between January 2018 and December 2020. We compare TB case detection in the facility before and after COVID-19 pandemic. Drug susceptibility testing were expressed as frequencies and percentages. ResultsThe study found that there was 66.03%, 45.09% and 77.78% drop in case detection of drug-sensitive TB (DSTB), DRTB and Fluoroquinolone (FQ) resistant TB respectively in the year 2020 compared to 2019. The drop in cases was similar when the year 2020 was compared to 2018. Among the 132 patients in the cohort, resistance to isoniazid, fluoroquinolones and second-line injectable agents were reported as 23.48%, 12.88%, and 31.06% respectively. ConclusionWe question the potential reason why a drop in tuberculosis cases was observed in the year 2020 and we alert the Nigerian authorities that COVID-19 control efforts going hand-in-hand with intensified TB case finding and surveillance efforts and initiating proper TB treatment for persons with active TB are urgently needed.

Mycobacterium tuberculosis Complex Mutations in Drug Resistant Clinical Isolates from Southwest Mexico

Mutations in target genes have been described in Mycobacterium tuberculosis Complex (MTBc) drug resistant isolates worldwide. In Mexico, not enough information has been reported in this concern. The aim of this study was to characterize mutations related to resistance to first line drugs in MTBc isolates from Oaxaca, Mexico. MTBc isolates were identified in clinical samples from Tuberculosis (TB) patients. Susceptibility to isoniazid, rifampin, ethambutol, streptomycin and pyrazinamide was tested through nitrate reductase assay. PCR based analysis and sequencing were employed to characterize mutations in katG, inhA, rpoB, embB, rrs, rpsL and pncA genes. Mutations in katG and the promoter of the mabA-inhA operon were found in isoniazid resistant isolates. Sequence analysis of Rifampin Resistance-Determining Region in the rpoB gene showed novel mutations along this region besides mutations at codons 516, 526 and 531. Polymorphisms at codon 306 embB gene were found in ethambutol resistant isolates. Frequent mutations associated to resistance to streptomycin were characterized in rrs and/or rpsL genes. pncA analysis showed variable number of mutations in resistant and susceptible pyrazinamide isolates. Most frequent mutations related to resistance to first line antituberculous drugs were identified in phenotypically resistant MTBc isolates. New mutations were characterized in rpoB, rrs and rpsL genes.

An Unusual Case of Multidrug Resistant Miliary Tuberculosis

Introduction: Miliary Tuberculosis (TB) is a rare and lethal form of TB and needs urgent detection and treatment. Miliary TB due to drug-resistant strains of Mycobacterium tuberculosis is even more difficult to manage. We present clinical and bacteriologic findings of a rare case of miliary multi-drug resistant tuberculosis (MDR-TB). Case Presentation: Our case was a young female patient with in vitro fertilization (IVF) pregnancy, who had radiological diagnosis of miliary TB and had not responded to antituberculous therapy with four drugs. Second line antituberculous drugs were started empirically and definite diagnosis of MDR-TB was obtained by culture and drug susceptibility test of biopsy specimens. Conclusions: Although very rare, MDR miliary TB can be seen in immunocompetent subjects. We, thereby, emphasize that early recognition and initiation of treatment are associated with a significant improvement in outcomes. Tuberculosis remains a serious worldwide health problem associated with high morbidity and mortality.

The role of supplementary vitamin D in treatment course of pulmonary tuberculosis

BackgroundVitamin D insufficiency/deficiency is associated with impaired immune function and increased risk of active pulmonary tuberculosis (TB). ObjectivesTo evaluate the role of vitamin D as supplementary treatment with the first line anti-tuberculous drugs (rifampicin, izoniazide, ethambutol and pyrazinamide) in treatment course of patients with active pulmonary tuberculosis. MethodsWe conducted a case-control study in El Maamora chest hospital, Alexandria governorate, Egypt, including 60 adult patients with active pulmonary TB of 30 patients each. Patients in group I (cases) received vitamin D (200,000 IU) intramuscular injection once besides anti-tuberculous drugs, while patients in group II (controls) were randomly selected from the hospital registry who received the first line anti-tuberculous treatment only. The primary outcome was evaluation of conversion time of sputum smear. The secondary outcome was clinical improvement as assessed by TB score. Measurements and main resultsMean±SD age of all patients was 41.55±14.91years. The study included 44 (73.3%) males and 16 (26.7%) females. Vitamin D deficiency/insufficiency was detected in 54 (90%) patients. Comparing the two groups, there was a rapid decline in sputum conversion time and severity classes of TB score in group I compared to group II (p<0.001 and p=0.02, respectively). No complications secondary to supplementary vitamin D were met all through the study. ConclusionVitamin D accelerates the improvement observed in vitamin D supplemented TB therapy. Vitamin D is safe when added to anti-tuberculous drugs. Vitamin D deficiency/insufficiency is common among TB patients. Further studies are required to validate this observation and define a cut off of vitamin D level to prevent immunological alterations.

Resistencia primaria a fármacos anti-tuberculosos en Chile 2011-2012

This publication presents the results of the Chilean initial study of resistance to first line anti-tuberculous drugs. The study was carried out between 2011 and 2012 by the National Reference Laboratory of the Institute of Public Health, as part of the Drug Surveillance Resistance in tuberculosis (TB) promoted by the World Health Organization. Cross-sectional study performed using cluster sampling, representative of the entire country as recommended by the World Health Organization. Susceptibility testing to isoniazid, rifampicin, streptomycin, ethambutol and pyrazinamide was performed through the proportion method or Wayne's enzymatic method, as appropriate. 594 susceptibility tests were performed, showing an overall level of TB drug resistance of 8.6% and a prevalence of multidrug resistance of 1.3%. Indeed, the study showed a decrease in streptomycin resistance and an increase of isoniazid resistance in both mono-resistance and accumulated resistance compared to previous studies. No cases of mono-resistance to rifampicin were detected. An increased resistance to anti-TB drugs in Chile is observed, which despite being still low, is no less worrisome. Since 2014 the monitoring of drug resistance to TB is universally performed to avoid sub - diagnosis and treat each case according to the susceptibility profile.

Tuberculose ultrarésistante en Côte d’Ivoire

The emergence of tuberculosis with ultraresistant bacilli (TB-UR or XDR-TB) came to increase the threat concerning the progress realized in tuberculosis control. This observation establishes the only case of XDR-TB documented and published since the beginning of pharmacoresistant tuberculosis management in Ivory Coast from 2000 till 2010. This case was diagnosed in 2005 at a HIV-negative 32-year-old woman, initially declared MDR-TB. Looking forward to a treatment of category IV, she was treated by therapeutic truncated protocols recombining antituberculous molecules to which the patient was still sensitive. This treatment (PAS, cycloserin, ciprofoxacin, ethionamid, ethambutol and kanamycin) was introduced after 9 months of waiting and was completely led in ambulatory under the supervision of a member of the family. The diagnosis of XDR-TB concerned new tests of sensibility spread to second line antituberculous drugs in front of the absence of spits negativation at the end of 14 months of a second line treatment marked by frequent stock shortages. The death arose at M19 of treatment by chronic heart pulmonary. XDR-TB remains dark prognosis and is almost synonymic of "death sentence" in our countries with limited resources. The application of the international recommendations for tuberculosis management and better accessibility to antituberculous second line drugs would allow to prevent the appearance of such forms of tuberculosis.

Whole Genome Sequencing Based Characterization of Extensively Drug-Resistant Mycobacterium tuberculosis Isolates from Pakistan

Improved molecular diagnostic methods for detection drug resistance in Mycobacterium tuberculosis (MTB) strains are required. Resistance to first- and second- line anti-tuberculous drugs has been associated with single nucleotide polymorphisms (SNPs) in particular genes. However, these SNPs can vary between MTB lineages therefore local data is required to describe different strain populations. We used whole genome sequencing (WGS) to characterize 37 extensively drug-resistant (XDR) MTB isolates from Pakistan and investigated 40 genes associated with drug resistance. Rifampicin resistance was attributable to SNPs in the rpoB hot-spot region. Isoniazid resistance was most commonly associated with the katG codon 315 (92%) mutation followed by inhA S94A (8%) however, one strain did not have SNPs in katG, inhA or oxyR-ahpC. All strains were pyrazimamide resistant but only 43% had pncA SNPs. Ethambutol resistant strains predominantly had embB codon 306 (62%) mutations, but additional SNPs at embB codons 406, 378 and 328 were also present. Fluoroquinolone resistance was associated with gyrA 91–94 codons in 81% of strains; four strains had only gyrB mutations, while others did not have SNPs in either gyrA or gyrB. Streptomycin resistant strains had mutations in ribosomal RNA genes; rpsL codon 43 (42%); rrs 500 region (16%), and gidB (34%) while six strains did not have mutations in any of these genes. Amikacin/kanamycin/capreomycin resistance was associated with SNPs in rrs at nt1401 (78%) and nt1484 (3%), except in seven (19%) strains. We estimate that if only the common hot-spot region targets of current commercial assays were used, the concordance between phenotypic and genotypic testing for these XDR strains would vary between rifampicin (100%), isoniazid (92%), flouroquinolones (81%), aminoglycoside (78%) and ethambutol (62%); while pncA sequencing would provide genotypic resistance in less than half the isolates. This work highlights the importance of expanded targets for drug resistance detection in MTB isolates.

In Vitro Antimycobacterial Activity of Pakistani Beri Honey Using BACTEC MGIT 960.

Background. Tuberculosis (TB) is a chronic bacterial disease. Mycobacterium tuberculosis, being the leading member of the MTB complex, is the main cause of tuberculosis worldwide. Tuberculosis is managed with combination of drugs: streptomycin, isoniazid, rifampicin, ethambutol, and pyrazinamide. Over the recent past years resistance against first line antituberculous drugs has emerged rapidly throughout the world resulting in MDR strains. The new threat in the management of MDR-TB is the development of resistance against second line drugs: aminoglycosides, polypeptides, fluoroquinolones, and thioamides. Multidrug resistant (MDR) and extensively drug resistant TB (XDR) strains have become a major concern to control TB particularly in the developing countries. The need of the hour is to look for new modalities having antimycobacterial activity. Honey has been well known for its antibacterial activity. We intended to explore its antimycobacterial activity against MDR-TB. Objective. The objective of this study was to determine whether Pakistani Beri honey has any antimycobacterial activity. Method. The study was conducted in the Department of Microbiology, University of Health Sciences, Lahore. Clinical isolates (n = 21) of MDR-MTB were evaluated for their susceptibility to Beri honey. The isolates were provided, courtesy of Pakistan Medical Research Council. These isolates were identified by MTBc ID test (Becton & Dickinson) and further tested for their antimycobacterial activity using Beri honey. The honey was tested at the following concentrations (v/v): 1%, 2%, 3%, 4%, and 5% in MGIT 960. Growth controls were also inoculated with each isolate (growth control has no concentration of honey, only containing growth of isolate). Results. MDR-TB isolates (n = 21) were tested; 3 (14%) isolates were susceptible at 1% v/v honey, while at 2% v/v of honey 18 (86%) isolates were found to be susceptible. All the 21 isolates (n = 21) were susceptible at 3% v/v of honey. Conclusion. The present study clearly demonstrates that Pakistani Beri honey possesses significant antimycobacterial activity in vitro. The antimycobacterial activity of Pakistani Beri honey may, therefore, be exploited in an appropriate mouse model.

Resazurin Microtiter Assay Plate method for detection of susceptibility of multidrug resistant Mycobacterium tuberculosis to second-line anti-tuberculous drugs

BackgroundMany developed countries need a diagnostic test that is accurate, rapid, and economical in detecting multidrug-resistant tuberculosis. This study aims to evaluate Resazurin Microtiter Assay Plate in detecting susceptibilities of multidrug resistant Mycobacterium tuberculosis to second line anti tuberculous drugs. MethodsSusceptibility of multidrug resistant M. tuberculosis was evaluated against 5 second line anti tuberculous drugs by the colorimetric method using the Resazurin Microtiter Assay Plate Testing (REMA). ResultsDrug susceptibility testing for the second-line drugs was performed for 34 MDR M. tuberculosis isolates isolated from 40 sputum samples. Results of REMA were available after 8days of incubation. The agreement between the two tests for para-aminosalicylic acid, ethionamide, ofloxacin, kanamycin monosulfate and cycloserine was found to be 97.05%, 94.11%, 97.05%, 97.05% and 100%, respectively. The efficacy of REMA plate assay for PAS, ETH, OFX, KAN and CYL was 97.05%, 94.11%, 97.05%, 97.05% and 100%, respectively. ConclusionResazurin test was found to be reliable, simple to perform for the rapid detection of anti-tuberculous drug resistance and economically inexpensive.

P58 An audit of treatment outcomes for patients with tuberculosis diagnosed at an inner London teaching hospital between 2000 and 2010

BackgroundThe WHO has the ambition that 85% of patients starting treatment for TB achieve treatment success (cure or treatment complete).1 There has been considerable anxiety that poor treatment completion rates...

Drug resistance profiles of Mycobacterium tuberculosis isolates to first line anti-tuberculous drugs: A five years study

Background:Drug resistance is a major problem in the treatment of tuberculosis (TB). An estimate of drug resistance is extremely important in the epidemiology and control of TB. However, an assessment of the magnitude of drug resistance in TB is not very well described globally and data remains scantier for India. In view of this, we reviewed our data over last five years.Materials and Methods:Six hundred and seventy-three Mycobacterium tuberculosis isolates were subjected to drug susceptibility against primary anti-tuberculosis drugs by economic variant proportion method. All isolates resistant to isoniazid and rifampicin were taken as multi-drug resistant (MDR).Results:Out of the 673 strains tested, 95 (14.11%) showed monoresistance, 365 (54.23%) strains were found to be resistant to more than one drug. A total of 118 (17.53%) strains were found to be resistant to all the four drugs tested. MDR was seen with 320 (47.54%) isolates. This study observed maximum resistance with rifampicin (74.4%) followed by streptomycin (70.0%), isoniazid (53.2%), and ethambutol (21.7%).Conclusion:While this information may not reflect true prevalence of drug resistance in the region, this may help in further planning long term surveillance studies to know the trend of drug resistance in this area.

Optochiasmatic tuberculomas: a vision threatening paradoxical response in tuberculous meningitis

The single main cause of death from infectious diseases worldwide is tuberculosis, which is more prevalent in developing countries. Tuberculous meningitis (TBM) is a severe form of TB in which morbidity and mortality depend upon the stage of presentation. Intracranial brain parenchymal tuberculomas may form paradoxically, days to months after starting antituberculous drug therapy. Tuberculomas may develop in and around he optic chiasm and optic nerves after institution of antituberculous treatment as a quite rare occurrence in TBM; this may lead to severe visual loss if not treated properly. We describe a 56-year-old man with documented TBM being treated with first line antituberculous drugs who developed visual impairment 2 months after starting the treatment. MRI after gadolinium administration revealed multiple perichiasmatic and a few parenchymal ring enhancing lesions due to tuberculomas. The patient was treated with corticosteroids and antituberculous therapy was continued after which he recovered his vision gradually. Visual impairment developing in a patient on treatment with antituberculous drugs should give rise to a suspicion of rare optochiasmatic tuberculomas; this necessitates urgent contrast-enhanced MRI of the brain and prompt treatment with steroids.

Documento de consenso de la Sociedad Española de Infectología Pediátrica sobre la tuberculosis resistente a fármacos

Drug resistant tuberculosis (TB-R), and in particular, multidrug resistant tuberculosis (MDR-TB) is a global public health problem, as well as a problem in our country. Cases of TB-R and MDR-TB have increased mainly in HIV, immigrant and socially disadvantaged populations, but a notable increase in the general population has also been observed. This aspect reinforces the need for a systematic study of sensitivity of all the isolates in a reference laboratory to optimally guide the treatment. Children are especially vulnerable to this severe disease due to the limited knowledge of second line anti-tuberculous drugs, in terms of their pharmacokinetic data, optimal doses, or their long term toxicity, all this eventually resulting in the compassionate use of drugs. Another aspect which further complicates the management of R-TB in children is the limited yield of cultures, which frequently leads to clinician designing drug combinations according to the sensitivity of the initial strain. The epidemiological pattern in our country has currently changed. There is a reported increase in isoniazid-resistant strains; therefore, a four drugs regime is mandatory for the initial period in children, until reliable sensitivity results are available. Treatment should be directly observed or at least supervised by paediatricians. The management of latent infections or exposure to a resistant TB case also requires an accurate, strict and prolonged supervision by expert paediatricians. Authorities and health care professionals who deal with TB should be prepared to face this new phenomenon with appropriate measures. The knowledge of second line drugs for children, as well as mechanisms to ensure the therapeutic adherence and long term control of disease, are essential.

PREVALENCE OF DRUG RESISTANCE IN PULMONARY TUBERCULOSIS

OBJECTIVE: To determine the prevalence of primary and secondary drug resistance to first line anti-tuberculous drugs. STUDY DESIGN: A hospital-based cross-sectional observational study. PLACE AND DURATION: Department of Medicine Liaquat University Hospital Hyderabad/ Jamshoro & Institute of Chest Diseases Kotri from April 2005 to March 2007. PATIENTS AND METHODS: Fifty cases of Pulmonary tuberculosis (TB) randomly selected from both institutes who fulfilled the following criteria 1) Sputa showed positive smear for Acid Fast bacilli on Zeil Nelson Stain.2) Chest x-ray showed shadow consistent with TB. A detailed history, contact with TB patients, previous use of anti-tuberculous drugs and Chest x-ray was done. Sputa of all patients were sent for detail report and culture sensitivity. Descriptive and inferential statistical analysis was performed using SPSS version 14.0. RESULTS: Among 50 patients, 28(56%) were males and 22(44%) females, age ranged from 16-80 years (38.14 + 15.69). All 50 (100%) patients presented with fever and cough, haemoptysis in 36 (72%), chest pain in 9(18%) and dyspnea in 11(22%) cases, anemia in 39(78%) and lymphadenopathy in 12(24%). On chest x-ray examination, 19(38%) patients had multiple infiltrations, cavitations in 10(20%), fibrosis in 9(18%), consolidation in 5(10%), pneumothorax in 4(8%) and pleural effusion in 3(6%) cases. Sputum for AFB was positive in all cases. Twenty-one (42%) culture positive patients were of primary resistance and 29(58%) were of secondary resistance. Twenty (40%) were sensitive to five drugs, 9(18%) resistant to one drug, 11(22%) to two drugs, 7 (14%) to three drugs, 3(6%) to four drugs and none resistant to five drugs. CONCLUSION: In our setting, the prevalence of resistance to anti-tuberculous drugs is high and alarming. Strategy should be made for proper treatment and compliance of patients to avoid the development of drug resistance.

Frequency of tuberculous cervical lymphadenitis detection at a single laboratory in islamabad.

To determine the frequency of tuberculous cervical lymphadenitis and to evaluate the diagnostic efficacy of microscopy and conventional Lowenstein Jensen (LJ) culture technique in the diagnosis of cervical lymphadenitis caused by M. tuberculosis (MTB) Study Design: A descriptive, cross-sectional study. Place and Duration of the Study: Department of Mycobacteriology, Public Health Laboratories Division, National Institute of Health, Islamabad, from January 2003 to December 2004. A total of 220 patients from Pakistan Institute of Medical Sciences (PIMS), Islamabad, Federal Government Services Hospital (FGSH), Islamabad and Rawalpindi General Hospital (RGH), Rawalpindi, presenting with enlarged cervical lymph nodes (for at least six months), pain/ weight loss and low grade fever were studied for the presence of MTB from 142 lymph node biopsies, 60 FNA samples and 18 discharge fluids/swabs. All the samples were examined at NIH by ZN staining smear and culture on conventional LJ medium as well as on Bactec 12B medium using Bactec 460 TB system. The drug susceptibility testing of the isolates was performed on Bactec 460 TB system. NAP test on Bactec 460-TB system, Accuprobe and biochemical tests were employed to identify the mycobacterial isolates. M. tuberculosis accounted for 173 out of 220 cases of cervical lymphadenopathy. Maximum incidence was found to be in the age group 10-30 years with male to female ratio of 1:1.7. Discharge sinuses and abscess formation were uncommon. Biopsy tissue samples gave the maximum yield of positive mycobacterial cultures as all 142 biopsy samples being positive while only 50% (30/60) of FNA and 5.5% (1/18) of discharge fluids/swabs were positive. All the isolates were identified as M. tuberculosis. No atypical mycobacteria were recovered from the samples examined. All isolates were found to be susceptible to first line anti-tuberculous drugs i.e. Streptomycin, Isoniazid, Rifampicin and Ethambutol (SIRE). Tuberculosis was the major cause of cervical lymphadenopathy in the referral area. Culture of the biopsy tissue from the affected lymph nodes is a method of choice for laboratory diagnosis of tuberculous cervical lymphadenopathy.

Prevalence of initial drug resistance of mycobacterium tuberculosis in northern Kerala

50 patients with sputum smear positive pulmonary tuberculosis were evaluated for initial drug resistance to 4 first line anti-tuberculous drugs using Lowenstein Jenson method.17.7% of patients showed initial drug resistance out of which 2 were resistant to INH alone and 4 having multidrug resistant tuberculosis.

National Survey of Mycobacterial Diseases Other Than Tuberculosis in Korea

National Survey of Mycobacterial Diseases Other Than Tuberculosis in Korea

Tuberculosis in the west of Ireland 1986-1990.

A review of mycobacteria isolated from clinical samples from the Western Health Board Area (WHBA) for the years 1986 to 1990 was performed to establish the pattern of mycobacterial infection. The incidence of microbiologically proven cases of tuberculosis (13.3/100,000) and of sputum smear positive cases (6.2/100,000) was determined and correlated with notification data. M. bovis accounts for 6.3% of cases of microbiologically confirmed tuberculosis in this area. Resistance to one or more of the first line anti-tuberculous drugs was noted in 5.3% of isolates (excluding pyrazinamide resistance in M. bovis). Clinically significant isolates of mycobacteria other than tuberculosis (MOTT) were rare throughout the five year period. The overall incidence of microbiologically proven cases of tuberculosis is relatively high and M. bovis and drug resistant isolates of M. tuberculosis are relatively common.