MDR-TB Cases Research Articles

Whole genome sequencing analysis of multidrug-resistant tuberculosis in Singapore, 2006-2018.

There were 290 multidrug-resistant (MDR)-TB cases diagnosed in Singapore from 2006 to 2018. Eighty-one percent were foreign-born. Spoligotyping and MIRU-VNTR methods identified 108 patients in 24 clusters. The Beijing spoligotype accounted for 22 clusters. Whole genome sequencing (WGS) analysis reduced the number of clustered patients and clusters to 43 and nine respectively. One MIRU cluster was redefined into three WGS clusters. All the clusters had foreign-born source cases. Forty percent of local-born, versus 9% of foreign-born, MDR-TB cases belonged to WGS clusters. WGS more accurately elucidated potential MDR-TB transmission which was overestimated by conventional genotyping methods in Singapore.

The Correlation of Body Mass Index with Sputum Conversion Time in MDR-TB Patients Undergoing Treatment with Short Term Regimen at H. Adam Malik Medan General Hospital

Background: It was estimated about 10.4 million incidence of TB cases worldwide, of which 580,000 were MDR TB cases in 2015, however, only 125,000 were successfully found and treated. The World Health Organization (WHO) issued a recommendation of 9-11 month Short Term Regimen (STR) guideline that could provide satisfactory results in terms of successfull outcome, easier to control and also low-cost. The study aimed to analyze the correlation between Body Mass Index (BMI) and sputum conversion time in MDR TB patients undergoing treatment with STR and to determine the final treatment outcome using STR at H. Adam Malik Medan General Hospital, North Sumatra, Indonesia. Methods: This was a case series study of a total 76 MDR TB patients undergoing treatment using STR. Samples were obtained from medical record of the pulmonary isolation ward and MDR TB clinic at H. Adam Malik Medan General Hospital. Data were analyzed descriptively to identify the trend in sputum conversion from nine months of treatment. Results: The number of patients with normal BMI was 51.3% higher than those of low, very low and high BMI. The time to sputum conversion occured in the second month of treatment. All groups of BMI categories experienced conversions and normal BMI was higher in number. At the end of the treatment evaluation, the cure rate was 44.8%, the drop out was 28.9%, the regimen change was15.8%, died 9.2%, and moved 1.3%. Conclusion: There was a significant correlation between BMI and sputum conversion time in MDR TB patients. Good nutritional status was a predictor of treatment success.

Prevalence and factors associated with multidrug-resistant tuberculosis in South India

India accounts for about one-fourth of the global burden of MDR-TB. This study aims to assess the prevalence and factors associated with tuberculosis drug resistance among patients from South India. MTBDRplus assay and MGIT liquid culture performed on 20,245 sputum specimens obtained from presumptive MDR-TB cases during a six-year period from 2013 to 2018 were analyzed retrospectively. Univariate and multivariate logistic regression analysis was carried out to evaluate factors associated with MDR, Rifampicin mono-resistance, and Isoniazid mono-resistance. MDR, Rifampicin mono- resistant and Isoniazid mono-resistant TB were found in 5.4%, 2.5%, and 11.4% cases of presumptive MDR-TB, respectively. Based on the rpoB gene, true resistance, hetero-resistance, and inferred resistance to Rifampicin was found in 38%, 29.3%, and 32.7% of the 1582 MDR cases, respectively. S450L (MUT3) was the most common rpoB mutation present in 59.4% of the Rifampicin resistant cases. Of the 3390 Isoniazid resistant cases, 72.5% had mutations in the katG gene, and 27.5% had mutations in the inhA gene. True resistance, heteroresistance, and inferred resistance accounted for 42.9%, 22.2%, and 17.3% of the 2459 katG resistant cases, respectively. True resistance, heteroresistance, and inferred resistance for the inhA gene were found in 54.5%, 40.7%, and 4.7% cases, respectively. MDR-contact (AOR 3.171 95% CI: 1.747–5.754, p-0.000) treatment failure (AOR 2.17595% CI: 1.703–2.777, p-0.000) and female gender (AOR 1.315 95% CI: 1.117–1.548, p-0.001), were positively associated with MDR-TB. Previous TB treatment did not show a significant positive association with MDR (AOR 1.113 95% CI: 0.801–1.546, p-0.523). Old age (AOR 0.994 95% CI: 0.990–0.999, p-0.023) and HIV seropositivity (AOR 0.580 95% CI: 0.369–0.911, p-0.018) were negatively associated with MDR-TB. Although Rifampicin mono-resistance had a positive association with treatment failure (AOR 2.509 95% CI: 1.804–3.490, p < .001), it did not show any association with previous TB treatment (AOR 1.286 95% CI: 0.765–2.164, p-0.342) or with history of contact with MDR-TB (AOR 1.813 95% CI: 0.591–5.560, p-0.298). However, INH mono-resistance showed a small positive association with the previous history of treatment for TB (AOR 1.303 95% CI: 1.021–1.662, p-0.033). It was also positively associated (AOR 2.094 95% CI: 1.236–3.548, p-0.006) with MDR-TB contacts. Thus INH resistance may develop during treatment if compliance has not adhered too and may be easily passed on to the contacts while Rifampicin resistance is probably due to factors other than treatment compliance. MDR-TB, i.e. resistance to both Rifampicin and Isoniazid, is strongly correlated with treatment failure, spread through contact, and not to treatment compliance. The temporal trend in this region shows a decrease in MDR prevalence from 8.4% in 2015 to 1.3% in 2018. A similar trend is observed for Rifampicin mono-resistance and Isoniazid mono-resistance, pointing to the effectiveness of the TB control program. The higher proportion of inferred resistance observed for Rifampicin compared with INH may indicate a surfeit of mechanisms that enable rifampicin resistance. Association of MDR-TB with age, gender, and HIV status suggest the role of the immune system in the emergence of the MDR phenotype.

A case control study for factors of Multidrug Resistant Tuberculosis in East Sikkim, India

Abstract Background Tuberculosis (TB) remains a major public health problem in the developing world and India is the highest TB burden country in the world in terms of absolute number of incident cases that occur each year. The emergence of Multidrug Resistant Tuberculosis (MDR TB) is posing threat to global efforts of TB control. The hilly state of Sikkim has the highest proportion of MDR TB cases in India. Hence there is an emerging need to identify the factors for the rapid rise of MDR TB in Sikkim. Methods All the MDR TB cases registered under Revised National TB Control Programme in East district of Sikkim in the first &amp; second quarter of 2019 was compared with double the number of matched controls taken from the same geographical area and ethnicity but not from the same family members. Results A total of 78 cases and 156 controls were studied. The mean age of the study participants was 43 years (SD ± 14 years). The most statistically significant risk factors were as follows: overcrowding (OR 2.68); household air pollution (OR 2.55); inadequate ventilation (OR 2.05); previous history of tuberculosis (OR 4.03) with history of relapse/failure; known contact of MDR tuberculosis (OR 4.01); having diabetes (OR 3.96); smoking (OR 3.96) Conclusions This study shows that clinical and demographic features can be used to indicate higher risks of drug resistance in this setting. Information was obtained on why Sikkim being a small State with very less population and a good per capita expenditure in health has the highest proportion of MDR-TB in India. Key messages Sikkim is the smallest state in India with the highest proportion of MDR TB. Previous history of TB with history of relapse/failure, contact of MDR TB emerged as the most significant risk factors.

Using patient–centered approach for improving adherence to treatment in DS/DR–TB patients in Ukraine

Abstract Issue/problem Ukraine is among 30 high MDR-TB burden countries with about 6500 laboratory confirmed MDR-TB cases annually. Ukraine provides full coverage for first- and second-line TB drugs from the state budget. Nevertheless, successful treatment outcomes are one of the lowest in EECA region - 49% in MDR/RR-TB cases and 37% in XDR-TB. High rates of lost to follow-up (15.8%), treatment failed (18%) and died (15.9%) among MDR-TB cases contribute to unsuccessful treatment outcomes. Description of the problem A new intervention was introduced aimed at improving patients' adherence to treatment. Medical-psycho-social services (MPSS) provision based on patient-centered approach is provided to all patients. In 2018, project funded by GFATM was launched in 8 oblasts of Ukraine. All patients are assessed on treatment adherence before discharge from hospitals. Those with low adherence are referred to NGOs. MPSS starts from the patient's needs assessment followed by development of individual plan of support. MPSS is provided during the whole period of outpatient treatment and may include DOT/VOT, social workers' permanent support, food kits, psychologist counselling, transport and/or cell reimbursement, housing, documents restore, legal services and other services as per patients' needs. Electronic depersonalized database SyrEx is used for the project related notes. Results Total amount of TB/DR-TB patients treated in 2018-2019 is 8640 and 4246 accordingly. Cohort analysis is used for treatment outcomes assessment. Intervention allowed reducing the number of patients lost to follow up in DS/DR-TB (to 1.2% and 2.5% accordingly), treatment failed (to 5.4% and 10.9%) and number of died (to 2.1% and 3.2%) Lessons MPSS based on patient-centered approach improved successful treatment outcomes: to 91% in DS-TB patients and 82.3% in DR-TB. Further initiative scale-up is required as well as transition of MPSS services from donor funding to domestic.

A Cbnaat based Study on Rifampicin Resistance in Tuberculosis in East Godavari District

Background: Globally 1.2 million Tuberculosis deaths occurred among HIV negative people and an estimated 251000 deaths occurred among HIV positive people in 2018. TB continues to be a public health threat as about half a million news cases were Rifampcin resistant. CBNAAT offer the prospect of very high sensitivity approaching that of liquid culture for TB diagnosis. It also provides information on drug susceptibility to rifampicin, which is a surrogate marker for identification of MDR TB cases. Objectives- 1.To know the magnitude of rifampicin resistance among TB cases. 2. To find out the incidence of TB HIV co-infection. Materials &amp; Method: Monthly Data regarding CBNAAT results during the year 2019 January-December was collected from District Tuberculosis Center (DTC), East Godavari district. Statistical analysis used: Data was entered and analyzed in MS-EXCEL. Results: A total of 20364 cases were screened for tuberculosis using CBNAAT, out of which 9366 patients were PLHIV (people living with HIV/AIDS). Among all the patients who were screened, 1951(9.6%) were positive for mycobacterium tuberculosis. 93(0.45%) cases were resistant to rifampicin. Among the PLHIV patients, 241(2.6%) were positive for tuberculosis. In those PLHIV cases, 20(0.2%) were resistant to rifampicin suggesting that rifampicin resistance was more common in HIV/AIDS. Among previously treated tuberculosis cases prevalence of rifampicin resistance was 5.1% as compared to 1.5% &amp; 1.8% among newly diagnosed cases &amp; non-responders respectively. Conclusion: CBNAAT is an effective tool in the diagnosis of tuberculosis and in identifying drug resistant tuberculosis. In our study drug resistance to rifampicin was more common in PLHIV and also in previously treated tuberculosis patients. By increasing the case detection rate of RR TB and TB-HIV co-infection cases using CBNAAT as the first line of diagnostic procedure we can be able to treat cases effectively in order to achieve the Sustainable Developmental Goal(SDG) of ending TB by 2025 as committed by Government of India

Molecular detection of multidrug resistance pattern and associated gene mutations in M. tuberculosis isolates from newly diagnosed pulmonary tuberculosis patients in Addis Ababa, Ethiopia.

Multi-drug resistance is a major challenge in the control of tuberculosis. Despite newer modalities for diagnosis and treatment, people are still suffering from this disease. Understanding the common gene mutations conferring rifampicin and isoniazid resistance is crucial for the implementation of effective molecular tools at local and national levels. Hence, this study aimed to evaluate the molecular detection of rifampicin and isoniazid-resistant gene mutations in M.tuberculosis isolates in Addis Ababa, Ethiopia. Health Center-based cross-sectional study was conducted between January and September 2017 in Addis Ababa, Ethiopia. The collected sputum samples were processed for mycobacterial isolation and Region of difference 9 based polymerase chain reaction for species identification. To characterize the rifampicin and isoniazid-resistant M. tuberculosis isolates, a molecular genetic assay (GenoType MTBDRplus) was used; the assay is based on DNA-STRIP technology. Culture positivity was confirmed in 82.6% (190/230) of smear-positive newly diagnosed pulmonary tuberculosis cases enrolled in the study. From 190 isolates 93.2% were sensitive for both rifampicin and isoniazid, and 6.8% of the isolates were resistant to at least one of the tested anti-TB drugs. Gene mutations were observed in all studied multidrug resistance-associated gene loci (rpoB, katG, and inhA). Two isolates exhibited heteroresistance, a mutated, as well as wild type sequences, were detected in the respective strains. MDR-TB case was observed in 1.1% (2/190) of the cases. All the MDR-TB cases were positive for HIV and found to have a history of prior hospital admission. In our finding a relatively high prevalence of any drug resistance was observed and the overall prevalence of multidrug-resistant tuberculosis was 1.1%.The majority of drug-resistant isolates demonstrated common mutations. Heteroresistant strains were detected, signaling the existence of an M.tuberculosis population with variable responses to anti-tuberculosis drugs or of mixed infections.

Factors of Multidrug Resistance Tuberculosis

The tuberculosis study subjects were diagnosed on the basis of sputum microscopic examination. Tuberculosis is a chronic, communicable and infectious disease mainly caused by Mycobacterium tuberculosis. This case-control study was carried out among 104 MDR-TB cases and 104 drug sensitive tuberculosis cases as controls. Among cases and controls 66(63.5%) male and 38(36.5%) female tuberculosis patients were on treatment for tuberculosis under district tuberculosis centre Satara. Most of the study participants from both cases and controls group were from rural area. The male predominance was seen in both drug resistant and drug sensitive tuberculosis. Majority of study subject from cases (70.2%) and controls (68.3%) belonged to age group 19 to 40 years of age. So it was concluded that the primary infection that the patients have got is due to multidrug resistance tuberculosis contact. Among medical condition asthma found to be significantly associated with multidrug resistance tuberculosis.

Factors of Multidrug Resistance Tuberculosis

The tuberculosis study subjects were diagnosed on the basis of sputum microscopic examination. Tuberculosis is a chronic, communicable and infectious disease mainly caused by Mycobacterium tuberculosis. This case-control study was carried out among 104 MDR-TB cases and 104 drug sensitive tuberculosis cases as controls. Among cases and controls 66(63.5%) male and 38(36.5%) female tuberculosis patients were on treatment for tuberculosis under district tuberculosis centre Satara. Most of the study participants from both cases and controls group were from rural area. The male predominance was seen in both drug resistant and drug sensitive tuberculosis. Majority of study subject from cases (70.2%) and controls (68.3%) belonged to age group 19 to 40 years of age. So it was concluded that the primary infection that the patients have got is due to multidrug resistance tuberculosis contact. Among medical condition asthma found to be significantly associated with multidrug resistance tuberculosis.

Cost-effectiveness of treating multidrug-resistant tuberculosis in treatment initiative centers and treatment follow-up centers in Ethiopia.

BackgroundIn Ethiopia, MDR-TB has become a significant public health threat; therefore, the Ministry of Health introduced two treatment approaches for MDR-TB cases: treatment initiative center (TIC) and treatment follow-up center (TFC). TIC is where patients usually are diagnosed and start the treatment. At TFC, we follow MDR-TB patients until they completed the treatment. However, there is no evidence about the cost-effectiveness of the approaches. Therefore, this study aimed to analyze the cost-effectiveness of MDR-TB treatment in TIC and TFC.MethodsIn this study, we employed a full economic evaluation from a providers' perspective. We followed a hypothetical cohort of individuals from the age of 15 for a lifetime using a Markov model with five mutually exclusive health states. We used both primary and secondary data sources for the study. Ingredient-based costing approach was used. The costs include healthcare provider costs (recurrent and capital cost) and patient-side costs (direct and indirect). We use a human capital approach to estimate the indirect cost. The cost estimates were reported in the 2017 United States Dollar (US$), and effectiveness was measured using disability-adjusted life-years (DALYs) averted. Both costs and health benefits were discounted using a 3% discount rate. Both average and incremental cost-effectiveness ratios (ICER) were reported calculated. One-way and probabilistic sensitivity analyses were reported to determine the robustness of the estimates.ResultsThe cost per HIV negative patient successfully treated for MDR-TB was $8,416 at TIC and $6,657 at TFC. The average cost-effectiveness ratio per DALY averted at TFC was $671 and $1,417 per DALY averted at TIC. The incremental cost-effectiveness ratio (ICER) of MDR-TB treatment at TIC was $1,641 per DALYs averted.ConclusionThis study indicates that the treatment of MDR-TB at both TIC and TFC are cost-effective interventions compared with the willingness to pay threshold of three-times the GDP per capita in Ethiopia.

TO ASSESS THE ADVERSE EFFECT PROFILE OF SECOND LINE DRUG IN MDR TB PATIENTS

Method: Study including LPA /AFB CULTURE proven cases of MDR TB. Data will be collected from the patient attending the OPD &amp; IPD in the Dept. of Respiratory Medicine.&#x0D; Result: Out of 200 patients 71% were of male its shows that MDR T.B. more prevalent among males and female 29%. Out of 200 patients most of the patients come under 10-15 Kg/m2 BMI, so its shows that 64.5% patients comes it and disease more prevalent among under nutrition. Out of 200 patients, the present study shows that gastrointestinal side effects are the most common 42%. 09 patients have renal toxicity and 08 patients have Arthalgia and 06 patients have cutaneous reactions and 11 patients developed hepatitis and 07 patients have some psychiatric illness and 07 patients developed hearing defect.&#x0D; Conclusion: The present study shows that gastrointestinal side effects are the most common 42%. 09 patients have renal toxicity and 08 patients have Arthalgia and 06 patients have cutaneous reactions and 11 patients developed hepatitis and 07 patients have some psychiatric illness and 07 patients developed hearing defect. Overall, these findings emphasize the importance of continuing the systematic surveillance of M. tuberculosis isolates to monitor the trends of drug resistance in different patient categories.&#x0D; Keywords: Adverse, Second line &amp; MDR TB.

The Influence of Distance from Health Facility, Family Number at Home and TB History in Starting Treatment of MDR-TB in Medan

The national TB Program according to the long-term plan is to prevent and control of drug resistance through Management Program of MDR-TB. The objective of the program are reducing morbidity, mortality and transmission of MDR-TB. Medan is an area with the highest case of MDR-TB in Sumatera Utara Province. Until November 2018 MDR-TB case has been confirmed in the city of Medan as many as 324, which has not started the treatment are 61 patients (19%). This research using case-control design and population is all people with MDR-TB in Medan city that recorded in E-TB Manager data. Sample case is the confirmed MDR-TB person who has not started the treatment as many as 13 people while the control is a confirmed person MDR-TB and willing to start the treatment as many as 31 people. The data is collected through interview using questionnaires and has received approval from the Ethics committee of the Faculty of Nursing University of Sumatera Utara. The data analysis is conducted with the chi-square test and the OR calculation to assess which variables affect the action of beginning MDR-TB treatment. Results showed that there was no influence of the distance of health facilities (p = 0.188) and family number at home (p = 0.507) with the status of starting treatment MDR-TB. There was influence of historical of TB with the status of starting treatment respondent MDR-TB (p = 0.021)

Rising challenge of multidrug-resistant tuberculosis in China: a predictive study using Markov modeling

BackgroundMultidrug-resistant tuberculosis (MDR-TB) is on the rise in China. This study used a dynamic Markov model to predict the longitudinal trends of MDR-TB in China by 2050 and to assess the effects of alternative control measures.MethodsEight states of tuberculosis transmission were set up in the Markov model using a hypothetical cohort of 100 000 people. The prevalence of MDR-TB and bacteriologically confirmed drug-susceptible tuberculosis (DS-TB+) were simulated and MDR-TB was stratified into whether the disease was treated with the recommended regimen or not.ResultsWithout any intervention changes to current conditions, the prevalence of DS-TB+ was projected to decline 67.7% by 2050, decreasing to 20 per 100 000 people, whereas that of MDR-TB was expected to triple to 58/100 000. Furthermore, 86.2% of the MDR-TB cases would be left untreated by the year of 2050. In the case where MDR-TB detection rate reaches 50% or 70% at 5% per year, the decline in prevalence of MDR-TB would be 25.9 and 36.2% respectively. In the case where treatment coverage was improved to 70% or 100% at 5% per year, MDR-TB prevalence in 2050 would decrease by 13.8 and 24.1%, respectively. If both detection rate and treatment coverage reach 70%, the prevalence of MDR-TB by 2050 would be reduced to 28/100 000 by a 51.7% reduction.ConclusionsMDR-TB, especially untreated MDR-TB, would rise rapidly under China’s current MDR-TB control strategies. Interventions designed to promote effective detection and treatment of MDR-TB are imperative in the fights against MDR-TB epidemics.

Implementation fidelity of hospital based directly observed therapy for tuberculosis treatment in Bhutan: mixed-method study

BackgroundDirect observed treatment (DOT) has been implemented in Bhutan since 1997 and currently, it is offered in various model of delivery including a combination of hospital based, home based DOT and ambulatory DOT. Overall, treatment success rate for tuberculosis cases is higher than the global target; however, it is still need to be improved. Evaluation to the implementation fidelity of DOT is important to identify potential rooms for improvement. This study aimed to assess two major components of the program’s implementation fidelity: to assess patient’s adherence to DOT and explore factors for adherence; to assess provider’s compliance with DOT guideline and explore factors for compliance.MethodsThis research used a sequential explanatory mixed method. The conceptual framework of implementation fidelity was adopted to guide this study design. The cross-sectional study of TB patients was enrolled in two hospitals with highest TB load, between September to November 2017 in Bhutan. Interviewer assisted survey was conducted with 139 TB patients who visited the hospital in continuation phase. In-depth interview was then conducted with nine TB patients and four health staffs to explore the barriers and enablers of DOT.ResultsTotal of 61.9% (86/139) of patients has received DOT at intensive phase. Proportion was higher among MDR-TB cases (100%), and smear sputum positive TB cases (84.7%). In the continuation phase, 5.8% of patients took medicine at hospital, 48.9% at home and the rest 45.3% no longer practiced DOT. More than 90% of patient received correct dosage and standard regimen of anti-TB drugs according to the guideline. The key factors affecting poor adherence to DOT as perceived by patients were; lack of willingness to visit the clinic on daily basis due to long distance, financial implications and family support. However, patient’s satisfaction to the quality of TB treatment service delivery was high (98.6%). Providing incentives to the patient was most agreed enabler felt by both health workers and patients.ConclusionIn the selected hospital sites, the patient’s adherence to DOT and provider’s compliance with DOT guideline is partially implemented; the coverage and the duration of DOT is very low, therefore, need to revise and improve DOT model and structure.

Distribución geográfica y factores de riesgo de tuberculosis multidrogorresistente en el centro de Perú

Introducción. Se estima que el tratamiento para la tuberculosis multidrogorresistente (TB-MDR) fracasa en el 46% de los pacientes, situación que representa una crisis para la salud pública. En Perú, 6 personas se enferman de tuberculosis (TB) cada hora y de los 27 000 casos notificados de enfermedad activa por año, el 10% corresponde a TB-MDR.Objetivo. Determinar la distribución geográfica de la TB-MDR y los factores de riesgo de esta enfermedad en la región de Junín, ubicada en el centro de Perú. Materiales y métodos. Estudio longitudinal retrospectivo de casos y controles que incluyó 3 602 personas con diagnóstico de tuberculosis confirmado con cultivo positivo para Mycobacterium tuberculosis entre enero y diciembre de 2016. Los casos fueron los pacientes con diagnóstico de TB-MDR y los controles, los demás pacientes.Resultados. Se encontró una mayor prevalencia de casos de TB-MDR en la selva central de Perú, zona con alta incidencia de TB. Al realizar el análisis multivariado, se encontraron los siguientes factores de riesgo de multidrogorresistencia: antecedente de tratamiento de la TB (OR: 1.61, IC95%: 1.14-3.26), fracaso del tratamiento previo (OR: 5.84, IC95%: 4.03-8.21) y contacto intradomiciliario con personas con TB-MDR (OR: 91.57, IC95%: 34.56-289.14).Conclusiones. La distribución geográfica de la TB-MDR es de tipo no heterogéneo con alta incidencia en la selva central. En pacientes con diagnóstico reciente de TB, se debe considerar la posibilidad de TB-MDR si presentan alguno de los factores de riesgo identificados aquí y proceden de alguna zona de alta prevalencia de esta enfermedad.

Screening of inmates transferred to Spain reveals a Peruvian prison as a reservoir of persistent Mycobacterium tuberculosis MDR strains and mixed infections

It is relevant to evaluate MDR-tuberculosis in prisons and its impact on the global epidemiology of this disease. However, systematic molecular epidemiology programs in prisons are lacking. A health-screening program performed on arrival for inmates transferred from Peruvian prisons to Spain led to the diagnosis of five MDR-TB cases from one of the biggest prisons in Latin America. They grouped into two MIRU-VNTR–clusters (Callao-1 and Callao-2), suggesting a reservoir of two prevalent MDR strains. A high-rate of overexposure was deduced because one of the five cases was coinfected by a pansusceptible strain. Callao-1 strain was also identified in 2018 in a community case in Spain who had been in the same Peruvian prison in 2002–5. A strain-specific-PCR tailored from WGS data was implemented in Peru, allowing the confirmation that these strains were currently responsible for the majority of the MDR cases in that prison, including a new mixed infection.

The Effect Of Health Education On Prevention Of Tuberculosition Medicine Resistance In Lung TB Patients

Tuberculosis is a direct infectious disease caused by an acid-resistant aerobic bacterium. Indonesia is now ranked fifth in the world with the highest burden of pulmonary TB in the world. The estimated TB prevalence for all cases is 660,000 (WHO, 2010) and the estimated incidence is 430,000 new cases each year. While the MDR-TB rate is estimated at 2% of all TB cases, TB cases with re-treatment are estimated to be around 6,300 MDR-TB cases each year. One of promoting healthy behavior, the role of nurses through nursing interventions provides health education towards MDR-TB prevention behavior for the success of treatment in TB patients. The researcher formulated the research problem "is there an effect of health education on tuberculosis drug resistance prevention (MDR-TB) behavior with the DOTS strategy in pulmonary TB patients? The design of this study used Quasi-Experimental Design with the Pretest-Posttest Control Group Design approach. The sampling technique was by consecutive sampling. Bivariate statistical test uses independent t-test and dependent t-test. The number of samples of 63 respondents who will be divided into 3 intervention groups, namely groups with 1 intervention, groups with 2 interventions and groups with 3 interventions. The study was conducted at the Kramatjati Health Center in East Jakarta. The results of the study showed that the provision of health pen 3 times gave an increase in the value of knowledge and prevention with p- value of 0.005.

Next-generation sequencing of drug resistant &lt;i&gt;Mycobacterium tuberculosis&lt;/i&gt; clinical isolates in low-incidence countries

Drug resistant tuberculosis (TB), especially multidrug (MDR) and extensively drug-resistant (XDR) TB, is still a serious problem in global TB control. Slovenia and North Macedonia are low-incidence countries with TB incidence rates of 5.4 and 10.4 in 2017, respectively. In both countries, the percentage of drug resistant TB is very low with sporadic cases of MDR-TB. However, global burden of drug-resistant TB continues to increase imposing huge impact on public health systems and strongly stimulating the detection of gene variants related with drug resistance in TB. Next-generation sequencing (NGS) can provide comprehensive analysis of gene variants linked to drug resistance in Mycobacterium tuberculosis. Therefore, the aim of our study was to examine the feasibility of a full-length gene analysis for the drug resistance related genes (inhA, katG, rpoB, embB) using Ion Torrent technology and to compare the NGS results with those obtained from conventional phenotypic drug susceptibility testing (DST) in TB isolates. Between 1996 and 2017, we retrospectively selected 56 TB strains from our National mycobacterial culture collection. Of those, 33 TB isolates from Slovenian patients were isolated from various clinical samples and subjected to phenotypic DST testing in Laboratory for Mycobacteria (University Clinic Golnik, Slovenia). The remaining 23 TB isolates were isolated from Macedonian patients and sent to our laboratory for assistance in phenotypic DST testing. TB strains included were either mono-, poly- or multidrug resistant. For control purposes, we also randomly selected five TB strains susceptible to first-line anti-TB drugs. High concordance between genetic (Ion Torrent technology) and standard phenotypic DST testing for isoniazid, rifampicin and ethambutol was observed, with percent of agreement of 77%, 93.4% and 93.3%, sensitivities of 68.2%, 100% and 100%, and specificities of 100%, 80% and 88.2%, respectively. In conclusion, the genotypic DST using Ion Torrent semiconductor NGS successfully predicted drug resistance with significant shortening of time needed to obtain the resistance profiles from several weeks to just a few days.

Prevalence of Pre - Extensively Drug Resistance Tuberculosis (Pre XDR-TB) &amp; Extensively Drug Resistance Tuberculosis (XDR-TB) among Pulmonary Multidrug Resistance Tuberculosis at a Tertiary Care Hospital, Jamnagar

Aims and Objective: Many diseases have a high prevalence in India, accounting for one-fourth of the Tuberculosis (TB) cases in the world. In our study, we aimed to find the prevalence of Pre XDR-TB and XDR-TB amongst newly diagnosed cases of pulmonary MDR-TB who had never been previously treated with second-line drugs. A prospective study was conducted in Culture and Drug susceptibility testing laboratory, Jamnagar and its associated Drug-Resistant Tuberculosis (DR-TB) centre.&#x0D; Materials and Methods: Baseline second-line liquid culture DST has been recently integrated with the Revised National Tuberculosis Control Programme (RNTCP) diagnostic algorithm. We included 500 patients who were diagnosed in cases of pulmonary MDR-TB never exposed to second-line TB-Drugs. Mycobacterial Growth Indicator Tube method conducted in an RNTCP accredited Culture and Drug susceptibility testing laboratory, Jamnagar, as part of the evaluation in the public healthcare system from where patients were referred for diagnosis to us.&#x0D; Results: 585 MDR suspected sputum samples were received, 466 sputum samples were showing culture positive for acid-fast bacilli which were screened against second-line drug susceptibility testing by using of BACTEC MGIT 960 (MGIT 960) instrument. About 293 Mycobacterium samples were MDR-TB, 151 were Pre- XDR TB and 22 were XDR-TB.&#x0D; Conclusion: The prevalence of Pre XDR-TB and XDR-TB among MDR-TB patients were 32.4% and 4.7% respectively. The high prevalence of Pre XDR-TB (FQ) is alarming and of concern in the management of MDR-TB control in Jamnagar area.

First insights into circulating XDR and pre-XDR Mycobacterium tuberculosis in Southern Brazil

Drug-resistant tuberculosis (DR-TB) is major problem in the fight against TB. Multidrug resistant (MDR) TB patients have a reduced treatment success rates and for, extensively drug-resistant (XDR) TB the cure rate does not exceed 25% in many countries. To evaluate the pre-XDR-TB and XDR-TB prevalence and transmission in Rio Grande do Sul State, in southern Brazil, we performed a retrospective WGS-based analysis of 87 MDR-TB cases, aiming to identify resistance-conferring mutations and its phylogenetic distinctiveness. Using a five SNP threshold for genomic clustering, 60 strains were genomically linked within 10 clusters, including 14 likely transmission events identified by retrospective conventional epidemiological investigation. Moreover, five likely transmission events involved 17 patients deprived of liberty in the same prison establishment. Mutations associated with isoniazid and rifampicin resistance were identified respectively in 97.70% and 98.85% of MDR M.tb strains, more frequently in katG and rpoB genes. In total, we identified eight (9.19%) pre-XDR and four (4.59%) XDR M.tb strains. Resistance to ofloxacin was observed in seven (8.04%) strains, all of them presenting resistance-conferring mutations. Phenotypic resistance from capreomycin and kanamycin was found in seven (8.04%) and four (4.59%) strains respectively, but no classic mutations associated with resistance to these drugs was identified. The results put in evidence a scenario involving multiple phylogenetically distinctive clades associated with pre-XDR and XDR-TB in the largest state of southern Brazil, while stressing the potential of using WGS to predict anti-TB drug resistance and need to halt MDR-TB transmission in the region.