Pulmonary Multidrug-resistant Tuberculosis Patients Research Articles

Efficacy and Safety of Bufei Jiedu Granules in Treating Multidrug-Resistant Pulmonary Tuberculosis: A Multi-center, Double-Blinded and Randomized Controlled Trial.

To assess the efficacy and safety of Bufei Jiedu (BFJD) ranules as adjuvant therapy for patients with multidrug-resistant pulmonary tuberculosis (MDR-PTB). A large-scale, multi-center, double-blinded, and randomized controlled trial was conducted in 18 sentinel hospitals in China from December 2012 to December 2016. A total of 312 MDR-PTB patients were randomly assigned to BFJD Granules or placebo groups (1:1) using a stratified randomization method, which both received the long-course chemotherapy regimen for 18 months (6 Am-Lfx-P-Z-Pto, 12 Lfx-P-Z-Pto). Meanwhile, patients in both groups also received BFJD Granules or placebo twice a day for a total of 18 months, respectively. The primary outcome was cure rate. The secondary outcomes included time to sputum-culture conversion, changes in lung cavities and quality of life (QoL) of patients. Adverse reactions were monitored during and after the trial. A total of 216 cases completed the trial, 111 in the BFJD Granules group and 105 in the placebo group. BFJD Granules, as an adjuvant treatment, increased the cure rate by 13.6% at the end of treatment, compared with the placebo (58.4% vs. 44.8%, P=0.02), and accelerated the median time to sputum-culture conversion (5 months vs. 11 months). The cavity closure rate of the BFJD Granules group (50.6%, 43/85) was higher than that of the placebo group (32.1%, 26/81; P=0.02) in patients who completed the treatment. At the end of the intensive treatment, according to the 36-item Short Form, the BFJD Granules significantly improved physical functioning, general health, and vitality of patients relative to the placebo group (all P<0.01). Overall, the death rates in the two groups were not significantly different; 5.1% (8/156) in the BFJD Granules group and 2.6% (4/156) in the placebo group. Supplementing BFJD Granules with the long-course chemotherapy regimen significantly increased the cure rate and cavity closure rates, and rapidly improved QoL of patients with MDR-PTB (Registration No. ChiCTR-TRC-12002850).

Survival Probability in Multidrug Resistant Pulmonary Tuberculosis Patients in a South Indian Region

Background: Drug-resistant tuberculosis is a burgeoning threat to public health requiring novel strategies to combat the infection. Although national tuberculosis elimination programs focus on improving health services, challenges in eradicating tuberculosis still exist. Factors attributing to unfavorable outcomes are unknown in Warangal district of Telangana state. Methods: This study included 296 patients diagnosed with multidrug-resistant pulmonary tuberculosis. The study participants followed up for a maximum of 20 months to determine treatment outcomes. Statistical applications of Kaplan-Meier curve and log-rank test used to find the survival probabilities in subgroups. Results: The survival of multidrug-resistant pulmonary tuberculosis patients was ascertained, in male and female patients, aged between 31 and 50 years. Resistance to rifampicin was prominent. The study found a survival rate of 76.68% and a mortality rate of 23.31%. The log-rank test revealed a significant difference in survival in subcategories with and without comorbidities ( P = .03), non-adherence to treatment ( P = .0001), treatment duration ( P = .02), regimens ( P = .01), and grading of radiograph ( P = .0001). Conclusion: This study identified factors that influenced the survival probability of multidrug-resistant pulmonary tuberculosis patients, including comorbidities, weight band, non-adherence to treatment, treatment duration, regimens, and grading of radiograph. These findings emphasize the need for enhanced management strategies to improve treatment outcomes.

Particulate matter deposition and its impact on tuberculosis severity: A cross-sectional study in Taipei

The objective of this study was to examine the association between the lung lobe-deposited dose of inhaled fine particulate matter (PM2.5) and chest X-ray abnormalities in different lung lobes of pulmonary tuberculosis (TB), multidrug-resistant tuberculosis (MDR-TB), and non-tuberculosis mycobacteria infections (NTM). A cross-sectional study was conducted between 2014 and 2022, comprising 1073 patients who were recruited from chest department clinic in a tertial refer hospital in Taipei City, Taiwan. Ambient 1-, 7-, and 30-day PM2.5 exposure and the deposition of PM2.5 in different lung lobes were estimated in each subject. The β coefficient for PM2.5 and deposited PM2.5 in lungs with the outcome variables (pulmonary TB, MDR-TB, and NTM infection) was derived through regression analysis and adjusted for age, gender, BMI, smoking status, and family income. We observed that a 1 μg/m3 increase in ambient PM2.5 was associated with an increase of MDR-TB infections of 0.004 times (95%CI: 0.001–0.007). A 1 μg/m3 increase in 1-day and 7-day PM2.5 deposition in left upper lobe and left lower lobe was associated with an increase in chest X-ray abnormalities of 9.19 % and 1.18 % (95%CI: 0.87–17.51 and 95%CI: 0.08–2.28), and 4.52 % and 5.20 % (95%CI: 0.66–8.38 and 95%CI: 0.51–9.89) in left lung of TB patients, respectively. A 1 μg/m3 increase in 30-day PM2.5 deposition in alveolar region was associated with an increase in percent abnormality of 2.50 % (95%CI: 0.65–4.35) in left upper lobe and 3.33 % (95%CI: 0.65–6.01) in right middle lobe, while in total lung was 0.63 % (95%CI: 0.01–1.27) in right upper lobe and 0.37 % (95%CI, 0.06–0.81) in right lung of MDR-TB patients. Inhaled PM2.5 deposition in lungs was associated with an exacerbation of the radiographic severity of pulmonary TB, particularly in pulmonary MDR-TB patients in upper and middle lobes. Particulate air pollution may potentially exacerbate the radiographic severity and treatment resistance in individuals with pulmonary TB.

Factors influencing histoplasmosis incidence in multidrug-resistant pulmonary tuberculosis patients: A cross-sectional study in Indonesia.

Histoplasmosis is an infectious disease caused by the dimorphic fungus Histoplasma capsulatum, which in chronic conditions, is generally difficult to distinguish from pulmonary tuberculosis (TB) based on its clinical appearance; therefore, diagnostic errors could occur. Meanwhile, the prevalence of multidrug-resistant pulmonary TB (MDR-TB) in Indonesia remains high. Study determining the incidence of histoplasmosis in MDR-TB is unavailable worldwide. The aim of this study was to determine the risk factors of histoplasmosis incidence in MDR-TB patients in Indonesia. A cross-sectional was conducted at H. Adam Malik General Hospital, Medan, Indonesia and the ELISA platform (semi-quantitative) was used to detect histoplasma antibodies. Factors associated with histoplasmosis incidence among MDR-TB were determined using a Chi-squared test. A total of 50 MDR-TB patients were included this study of which 14 of them (28%) had histoplasmosis. The majority of histoplasmosis occurred in males, in MDR-TB patients with a history of TB treatment and among who had chest x-rays with far-advanced lesions. However, statistical analyses indicated none of those factors (sex, TB treatment history, status of the lung) as well as age group, acid-fast bacillus result, Mycobacterium tuberculosis culture result, having pet, living in damp house, working in the field or plantation, having HIV infection and smoking status were associated with histoplasmosis incidence. This study highlights that the incidence of histoplasmosis is relatively high and therefore further studies are important to be conducted in Indonesia that has a high MDR-TB cases.

Low serum vitamin D in North Indian multi-drug resistant pulmonary tuberculosis patients: the role of diet and sunlight

Background: Tuberculosis (TB) and malnutrition are major global health problems, with multidrug-resistant (MDR) TB complicating international efforts. The role of vitamin D in susceptibility to and as an adjunctive treatment for TB is being studied extensively, although no study has included MDR-TB patients in context to dietary profile with vitamin D levels and sunlight exposure.Objective: This study aimed to estimate vitamin D serum levels and examine their association with dietary intake of vitamin D and sun exposure in patients with MDR-TB.Methods: North Indian participants were enrolled in three groups: MDR-TB, drug-susceptible pulmonary TB (DS-PTB), and healthy controls. All consenting participants underwent the estimation of macro- and micronutrient intake and sunlight exposure using structured questionnaires. Serum biochemistry, including 25-hydroxyvitamin D and calcium levels, was measured, and the correlation between variables was determined.Results: 747 participants were enrolled. Significant differences among the three groups were found in mean serum 25-hydroxyvitamin D levels, body mass index, macronutrient intake, dietary vitamin D and calcium content, and sun exposure index (SEI). All except sun exposure (SEI was highest in DS-PTB patients) were found to follow the trend: MDR-TB < DS-PTB < healthy controls. The mean serum vitamin D levels of all groups were deficient and correlated positively with dietary intake and SEI.Conclusion: In this study’s we found significant association of serum vitamin D concentrations, dietary intake and sunlight exposure in MDR-TB, DS-PTB patients and healthy controls. Dietary intake may be more important than sun exposure in determining serum levels. However, the significance of this finding is uncertain. Further studies are required to confirm the association, direction, and potential for vitamin D supplementation to treat or prevent MDR-TB infection.

Study on the resistance of rifampicin-resistant Mycobacterium tuberculosis to anti-tuberculosis drugs in group A

Objective: To summarize the resistance of rifampicin-resistant Mycobacterium tuberculosis to anti-tuberculosis drugs in group A. Methods: In the retrospective study, a total of 1 226 clinical isolates from suspected multidrug-resistant pulmonary tuberculosis patients in Beijing TB control system from 2016 to 2021 were identified as Mycobacterium tuberculosis (MTB) strains by MPB64 antigen detection test. Rifampicin-resistant tuberculosis (RR-TB) strains were screened by the phenotypic drug susceptibility using the proportion method. The drug susceptibilities of Levofloxacin(LFX), Moxifloxacin(MFX), Bedaquiline(BDQ) and Linezolid(LZD)were detected by the phenotypic drug susceptibility with microplate method. The drug resistance rate, drug resistance level and minimum inhibitory concentration (MIC) distribution of four anti-tuberculosis drugs in group A were analyzed. We calculated the demographic distribution of RR-TB, multidrug-resistant tuberculosis(MDR-TB), pre-extensively drug resistant tuberculosis (pre-XDR-TB), extensively drug resistant tuberculosis (XDR-TB) patients and the cross resistance of LFX and MFX, then summarized the drug-resistance spectrum of BDQ-resistant and LZD-resistant strains and the treatment outcome of RR-TB patients. Measurement data were expressed as rate or composition ratio,χ2 test was used between and within groups, and P<0.05 was considered statistically significant. Results: Among the 1 226 suspected multidrug-resistant pulmonary tuberculosis patients, the detection rates of RR/MDR/pre-XDR/XDR-TB patients were 20.8%(255/1 226), 15.2%(186/1 226), 5.7%(70/1 226), 0.5%(6/1 226), respectively. There were statistically significant differences in the distribution of patients with the four types of drug resistance in terms of age and treatment history (χ2=14.95, P=0.020;χ2=15.91, P=0.001). The drug resistance rates of LFX, MFX, BDQ and LZD in RR-TB patients were 27.5% (70/255), 27.5% (70/255), 0.4% (1/255) and 2.4% (6/255), respectively. The MICs of LFX, MFX and LZD-susceptible MTB were mainly at 0.25 mg/L, and the MIC of BDQ-susceptible MTB was mainly concentrated at 0.03 mg/L. 25.1% (64/255) of the RR MTB were resistant to both LFX and MFX, and 6 strains were resistant to LFX or MFX, showing incomplete two-way cross resistance. One BDQ-resistant strain and six LZD-resistant strains were detected. The treatment success rate of RR-TB patients was 74.4% (151/203), and there were statistically significant differences in treatment outcomes between resistant and sensitive patients on the LFX-containing treatment regimen (Fisher's exact test, P=0.012). Conclusions: The prevalence of fluoroquinolones (LFX and MFX) resistance in rifampicin-resistant MTB is very serious. LFX and MFX show incomplete bidirectional cross-resistance. BDQ and LZD have the most promising future in the treatment of MDR-TB. Improve drug-resistance testing will help to further improve the success rate of treatment.

Prevalence And Risk Factors Of Multi Drug Resistant Tuberculosis In Children.

To assess the prevalence of drug-resistant tuberculosis and to identify possible risk factors in children. The descriptive, interview-based study was conducted at the Pulmonology outdoor clinic of Jinnah Hospital, Lahore, Pakistan, from January to August 2019, and comprised children aged up to 14 years who were either contacts of a multi-drug resistant tuberculosis patients or non-contacts. Data related to their demography as well as clinical and social characteristics was collected using a questionnaire. Data was analysed using SPSS version 22. Of the 202 subjects, 115(56.9%) were girls and 87(43.1%) were boys. There were 70(34.7%) subjects aged >13 years, followed by 45(22.3%) aged 9-12 years, 44(21.8%) aged £4 years and 43(21.3%) aged 5-8 years. Overall, there were 26(12.9%) cases positive for multi-drug resistant tuberculosis; 16(61.5%) girls and 10(38.5%) boys. In terms of age, 17(65.4) cases were positive in those aged >13 years. Age, previous history of tuberculosis, co- infection with any immune-compromising disease and close contact with patients of multi-drug resistant tuberculosis were significant risk factors identified. The prevalence of multi-drug resistant tuberculosis was high in contacts of multi-drug resistant pulmonary tuberculosis patients, more prevalent in children aged 13-14 years.

The Role of Omega-3/Omega-6 Ratio on Appetite in Pulmonary Multidrug-Resistant Tuberculosis Patients

Introduction: Tumour necrosis factor-alpha (TNF-α) levels, pro-inflammatory cytokines that suppress appetite, were discovered to be much higher in multidrug-resistant tuberculosis (MDR-TB) than in drug-sensitive TB. Research on the omega-3/omega-6 (ꞷ-3/ꞷ-6) polyunsaturated fatty acids (PUFAs) intake, which can support appetite in patients with MDR-TB, has never been performed. This study aimed to examine the relationship between ꞷ-3/ꞷ-6 PUFAs intake ratio and appetite mediated by TNF-α in pulmonary MDR-TB patients. Methods: This was a cross-sectional study conducted on 46 male and female adults with MDR-TB undergoing intensive phase therapy. Data were collected through questionnaires, 1x24 hours food recall, anthropometric measurements, 100 mm visual analogue appetite scale, and venous blood collection. Results: Correlation analysis used the Pearson and Spearman tests. The findings revealed the ratio of ꞷ-3/ꞷ-6 PUFAs intake of 0.11 ± 0.05, the median value of TNF-α 7.49(1.66-447.62) pg/mL, and an average appetite of 58.72 ± 26.7. There was no relationship between ꞷ-3/ꞷ-6 PUFAs intake ratio and TNF-α (r = 0.016; p = 0.91), likewise between ꞷ-3/ꞷ-6 PUFAs intake ratio with appetite (r = -0.1; p = 0.54), but there was a relationship between TNF-α and appetite (r = 0.031; p = 0.04). Conclusion: There was no relationship between ꞷ-3/ꞷ-6 PUFAs intake ratio and TNF-α and appetite in pulmonary MDR-TB patients. However, there was a relationship between TNF-α and appetite. This study is the first to determine the correlation between ꞷ-3/ꞷ-6 PUFAs intake ratio and appetite in pulmonary MDR-TB patients.

Pre-extensively drug-resistant tuberculosis among pulmonary multidrug-resistant tuberculosis patients in Eastern Nigeria.

Pre-extensively drug-resistant tuberculosis (Pre-XDR-TB), an emerging form of drug-resistant tuberculosis, is challenging efforts at tuberculosis control, leading to treatment failure among multidrug-resistant tuberculosis (MDR-TB) patients and progression to extensively drug-resistant tuberculosis (XDR-TB). We determined the rate of Pre-XDR-TB among multidrug-resistant patients in Southeast, Nigeria. A prospective laboratory-based study was carried out at the South East Zonal Tuberculosis Reference Laboratory from January 2021 to December 2021. Second-line drug (SLD) resistance was performed on 225 sputum samples of multidrug-resistant patients prior to treatment initiation using GenoType MTBDRsl genotypic drug susceptibility testing (DST) method. The rate of Pre-XDR-TB among 225 MDR-TB cases was 3.1%. Fluoroquinolone-resistant Pre-XDR-TB was observed (100%) in previously treated tuberculosis cases. Only one (0.4%) case showed resistance to both fluoroquinolone (FQ) and one second-line injectable drug (XDR-TB). The extensively drug-resistant case observed was a de-novo resistance. Exactly 0.9% of the multidrug-resistant cases showed resistance to second-line injectables. The prevalence of Pre-XDR-TB among MDR-TB cases was high. There is need for rapid detection of Pre-XDR-TB among MDR-TB cases before treatment initiation.

Predictors for Mortality in Multidrug Resistant Pulmonary Tuberculosis Patients in a South Indian Region

Background: Although various factors depicting the mortality in multi drug resistant tuberculosis available there exist no concise data on the factors contributing to mortality globally. The predictors for mortality in multi drug resistant tuberculosis patients vary from localities. Objectives: The study aimed to find the factors contributing to mortality in multi drug resistant tuberculosis in Warangal district of Telangana. Materials and Methods: The prospective study determining the predictors of mortality in multidrug resistant pulmonary tuberculosis patients had a sample size of 296. The follow-up of the patients was conducted for twenty four months to determine the treatment outcome. Patients’ mortality was noted from the hospital case sheets, relatives and healthcare facilitators’ viz., National tuberculosis elimination program supervisors, Auxiliary Nursing Midwifery in case of death at home. Patients’ demography was denoted in number and percentage. Predictors for mortality determined using binary logistic regression analysis. The predictor variables significant with p&lt;0.2 in univariate analysis were considered for binary logistic regression analysis. The dependent variable was the occurrence of event - mortality and the independent variables chosen from the available literature. Results: The predictors for mortality identified as low body weight of 16-30kg (p=0.002; aOR=10.43); comorbids (p=0.002; aOR=3.21); severe radiological manifestations at admission to hospital (p=0.001; aOR=6.98) and incompliance to treatment (p=0.0001; aOR=5.06) in the present study. Conclusion: The factors identified for mortality in multidrug resistant tuberculosis patients are malleable and modifiable with timely follow-up of the patients. The results imply strengthening the anti-TB program with a multidisciplinary approach for a systematic follow-up of the patients and favorable treatment responses.

Multi-modal deep learning based on multi-dimensional and multi-level temporal data can enhance the prognostic prediction for multi-drug resistant pulmonary tuberculosis patients

Despite the advent of new diagnostics, drugs and regimens, multi-drug resistant pulmonary tuberculosis (MDR-PTB) remains a global health threat. It has a long treatment cycle, low cure rate and heavy disease burden. Factors such as demographics, disease characteristics, lung imaging, biomarkers, therapeutic schedule and adherence to medications are associated with MDR-PTB prognosis. However, thus far, the majority of existing studies have focused on predicting treatment outcomes through static single-scale or low dimensional information. Hence, multi-modal deep learning based on dynamic data for multiple dimensions can provide a deeper understanding of personalized treatment plans to aid in the clinical management of patients.

Thoracic Radiography Findings of Multi Drug Resistant Tuberculosis at Dr. Hasan Sadikin General Hospital Bandung

Background: The prevalence of multidrug-resistant pulmonary tuberculosis (MDR-TB) continues to increase, especially in Indonesia. Thoracic radiography examination plays a role in the TB diagnosis by providing findings of typical lesions in patients. The aim of the study was to determine the thoracic radiography findings in MDR-TB patients.Methods: This was a cross-sectional retrospective descriptive study. This study had explored secondary data from medical records of patients who previously had a clinical diagnosis of MDR-TB and underwent thoracic radiography examinations at the Department of Radiology, Dr. Hasan Sadikin General Hospital, Bandung on July - August 2020 Result: Of 110 data collected, the average age was 37±12.6 years with male patients were predominantly prevalent and 65.5% had large lesions. The most frequent findings of lesions were calcification (94.5%) and fibrosis (90.9%). Other major findings were infiltration (88.2%), consolidation (55.5%), cavity (65.5%), ground-glass opacity (60.9%) while other were found in less than half of the cases such as bronchiectasis (23%), nodule (34.5%), atelectasis (36.4%), lymphadenopathy (34.5%), and others. Interestingly, the miliary pattern was not found.Conclusion: Large lesions, calcification, fibrosis, infiltration, consolidation, cavities, and ground-glass opacities are the main features of the radiographic findings in the majority of MDR-TB patients.

Population Pharmacokinetic Modeling of Bedaquiline among Multidrug-Resistant Pulmonary Tuberculosis Patients from China.

ABSTRACTBedaquiline has been widely used as a part of combination dosage regimens for the treatment of multidrug-resistant tuberculosis (MDR-TB) patients with limited options. Although the effectiveness and safety of bedaquiline have been demonstrated in clinical trials, limited studies have investigated the significant pharmacokinetics and the impact of genotype on bedaquiline disposition. Here, we developed a population pharmacokinetic model of bedaquiline to describe the concentration-time data from Chinese adult patients diagnosed with MDR-TB. A total of 246 observations were collected from 99 subjects receiving the standard recommended dosage. Bedaquiline disposition was well described by a one-compartment model with first-order absorption. Covariate modeling identified that gamma-glutamyl transferase (GGT) and the single-nucleotide polymorphism (SNP) rs319952 in the AGBL4 gene were significantly associated with the apparent clearance of bedaquiline. The clearance (CL/F) was found to be 1.4 L/h lower for subjects with allele GG in SNP rs319952 than for subjects with alleles AG and AA and to decrease by 30% with a doubling in GGT. The model-based simulations were designed to assess the impact of GGT/SNP rs319952 on bedaquiline exposure and showed that patients with genotype GG in SNP rs319952 and GGT ranging from 10 to 50 U/L achieved the targeted maximum serum concentration at steady state (Cmax,ss). However, when GGT was increased to 100 U/L, Cmax,ss was 1.68-fold higher than the highest concentration pursued. The model developed provides the consideration of genetic polymorphism and hepatic function for bedaquiline dosage in MDR-TB adult patients.

Endobronchial Valve Treatment of Tuberculous Cavities in Patients with Multidrug-Resistant Pulmonary Tuberculosis: A Randomized Clinical Study.

Background: Multidrug-resistant pulmonary tuberculosis (MDR-PTB) has become a major cause of high morbidity and mortality related to TB. Conventional drug regimens are ineffective for the treatment of MDR-PTB patients with cavities. This study aimed to evaluate the clinical efficacy and safety of one-way endobronchial valves (EBVs) for the treatment of cavities in MDR-PTB patients. Methods: MDR-PTB patients with positive sputum cultures, sputum smears, and cavities were treated with EBVs in the drainage bronchus of the pulmonary cavity between November 2013 and March 2018. The participants comprised those who had failed previous anti-tuberculosis therapy, as determined by drug susceptibility testing. Results: Thirty-five MDR-PTB patients were included, three of whom were lost during follow-up. The size of the lung cavity was reduced in all of the patients after EBV implantation, including the three lost to follow-up. In the remaining 32 patients, the sputum culture conversion (SCC) rate reached 100%, and the cavity closure rate was 68.8%. There were no significant differences in the cavity closure rate between patients aged ≤40 and >40 years, between the upper and lower lobes, or between the use and non-use of linezolid groups (p > 0.05). Interestingly, the cavity closure rate was higher in women than in men (p = 0.005). Moreover, the cavity closure rate correlated with the time to SCC (correlation coefficient, 0.8933; p < 0.0001). There were no severe adverse events in the patients treated with EBV implantation. Conclusion: EBV installation is effective and safe for the treatment of cavities in MDR-PTB patients. The efficacy of EBV treatment may not be affected by age, disease course, or the location of the lung lobe in the cavity.

Bedaquiline, Delamanid, Linezolid and Clofazimine for Treatment of Pre-extensively Drug-Resistant Tuberculosis.

Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) remain low globally. Availability of newer drugs has given scope to develop regimens that can be patient-friendly, less toxic, with improved outcomes. We proposed to determine the effectiveness of an entirely oral, short-course regimen with Bedaquiline and Delamanid in treating MDR-TB with additional resistance to fluoroquinolones (MDR-TBFQ+) or second-line injectable (MDR-TBSLI+). We prospectively determined the effectiveness and safety of combining two new drugs with two repurposed drugs - Bedaquiline, Delamanid, Linezolid, and Clofazimine for 24-36 weeks in adults with pulmonary MDR-TBFQ+ or/and MDR-TBSLI+. The primary outcome was a favorable response at end of treatment, defined as two consecutive negative cultures taken four weeks apart. The unfavorable outcomes included bacteriologic or clinical failure during treatment period. Of the 165 participants enrolled, 158 had MDR-TBFQ+. At the end of treatment, after excluding 12 patients due to baseline drug susceptibility and culture negatives, 139 of 153 patients (91%) had a favorable outcome. Fourteen patients (9%) had unfavorable outcomes: four deaths, seven treatment changes, two bacteriological failures, and one withdrawal. During treatment, 85 patients (52%) developed myelosuppression, 69 (42%) reported peripheral neuropathy, and none had QTc(F) prolongation >500msec. At 48 weeks of follow-up, 131 patients showed sustained treatment success with the resolution of adverse events in the majority. After 24-36 weeks of treatment, this regimen resulted in a satisfactory favorable outcome in pulmonary MDR-TB patients with additional drug resistance. Cardiotoxicity was minimal, and myelosuppression, while common, was detected early and treated successfully.

Pattern of Drug-resistance and Treatment Outcome in Multidrug-resistant Pulmonary Tuberculosis

To study the pattern of drug-resistance and treatment outcomes among patients with confirmed multidrug-resistant pulmonary tuberculosis (MDR-PTB). A prospective study was conducted at Rajiv Gandhi Institute of Chest Diseases, Bengaluru, Karnataka, India. Between January 2005 and December 2008, 224 confirmed MDR-PTB cases were studied for various drug-resistance patterns, and their treatment outcomes were analysed until November 2010. Sputum culture and drug sensitivity tests (DST) were carried out at National Tuberculosis Institute, Bengaluru; DST was done for all first-line drugs except pyrazinamide. Of the 224 MDR-PTB patients, 146 (65.2%) were resistant to all first-line drugs, 39 (17.4%) to isoniazid, rifampicin and streptomycin; 19 (8.5%) to isoniazid, rifampicin and ethambutol; and 20 (8.9%) to isoniazid and rifampicin. Among them, 145 (64.7%) patients were cured, 5 (2.2%) had treatment-failure, 10 (4.4%) died, and 64 (28.5%) defaulted. Among 145 cured cases, 100 (69%) were resistant to all first-line drugs, 23 (16%) to isoniazid, rifampicin and streptomycin, 11(8%) to isoniazid, rifampicin and ethambutol, and 11(8%) to isoniazid and rifampicin. The most common pattern observed in this study was resistance to all four first-line drugs followed by resistance to isoniazid, rifampicin and streptomycin. Patients resistant to all first-line drugs had early sputum culture conversion and better cure rate as compared to other resistance patterns.

Radiological evidence in clinical prevalence of hematological changes in multidrug resistant pulmonary tuberculosis

Background: Globally, tuberculosis is the leading cause of death. India accounts for the highest proportion of drug resistant tuberculosis among all other countries. Objectives: This study investigated the changes in hematological parameters with respect to radiological evidences in multidrug resistant tuberculosis patients. Materials and Methods: The study enrolled a total of 273 patients with the confirmative diagnosis of multidrug resistant tuberculosis. The radiological evidences were classified into mild, moderate and severe lung involvement. Results: The chest radiographs illustrated tracheal deviation (74), loss of lung volume (35), pleural effusion (25), lobar collapse and fibrotic manifestations. The defensive leucocytes, phagocytic neutrophils, anucleated platelet cells and platelet volume observed an increase with severe lung grading (p&lt;0.0001). Reduced lymphocyte count, mean platelet size observed with the intense lung involvement. Prevalence of normocytic, normochromic anemia, anisocytosis was prominent in these patients. The erythrocyte sedimentation rate observed no significant changes in the categorized radiological grades of lung. Radiological grading reported a weak positive correlation with the hematological parameters. Conclusion: The study noticed the changes in the complete blood count parameters with radiological signs and recommend monitoring of these investigations in determining the progression of the lung involvement in the multidrug resistant pulmonary tuberculosis patients.

Development of Scoring and Stratification of Severe Lung Involvement in Multidrug-Resistant Pulmonary Tuberculosis Patients

Development of Scoring and Stratification of Severe Lung Involvement in Multidrug-Resistant Pulmonary Tuberculosis Patients

A Retrospective Comparative Study on Median Time to Sputum Culture Conversion in Multi-Drug Resistant Pulmonary Tuberculosis Patients in Pastoral and Non-Pastoral Settings in Southeast Oromia, Ethiopia.

PurposeSputum culture conversion to negative is an indicator of good interim treatment outcome. Pastoralist community has lesser access to healthcare services. This study aimed to compare the time to culture conversion (TTSCC) between the pastoral and non-pastoral settings and identify its determinants among drug-resistant pulmonary TB patients.Patients and MethodsFour hundred forty-seven drug-resistant pulmonary TB patients were included from selected hospitals of southeastern Oromia, Ethiopia. Kaplan–Meier model using the Log rank test was fit to compute and compare median TTSCC between study participants from the pastoral and non-pastoral settings. The Cox proportional hazard model was fit to identify factors associated with the TTSCC. Adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was used to report the strength of association. Statistical significance was declared at p < 0.05.ResultsThe study participants’ median age (interquartile range) was 29 (24–36) years. The overall median TTSCC among the current study participants was 67 (95% CI, 64–70) days. It was significantly different for patients from the pastoral and non-pastoral settings (p-value <0.001). The median TTSCC for patients from pastoral and non-pastoral settings was 101 (95% CI, 81–121) and 63 (95% CI, 61–64) days. To mention few determinants, patients from the pastoral setting had a 69% lower chance [HR = 0.31 (95% CI 0.24–0.41)] of shorter TTSCC than patients from the non-pastoral setting. Furthermore, patients with baseline body mass index greater than 18.5Kg/M2 had a 35% higher chance of shorter TTSCC [HR = 1.35 (95% CI 1.07–1.71)] compared to their counterparts.ConclusionThe median TTSCC among the study participants from pastoral was longer than those from non-pastoral setting. The pastoral setting, under-nutrition, previous exposure to anti-TB drugs and drug regimen categories were among the notable determinants of the TTSCC among our study participants. Hence, due attention should be given to patients with these determinants during the treatment.

New Approaches in the Classification and Prognosis of Sign Clusters on Pulmonary CT Images in Patients With Multidrug-Resistant Tuberculosis.

Background: To date, radiographic sign clusters of multidrug-resistant pulmonary tuberculosis (MDR-TB) patients have not been reported. We conducted a study to investigate the classification and prognosis of sign clusters in pulmonary Computed Tomography (CT) images from patients with MDR-TB for the first time by using principal component analysis (PCA).Methods: The clinical data and pulmonary CT findings of 108 patients with MDR-TB in the Liupanshui Third Hospital were collected (from January 2018 to December 2020). PCA was used to analyze the sign clusters on pulmonary CT, and receiver operating characteristic (ROC) analysis was used to analyze the predictive value of the treatment outcome of MDR-TB patients.Results: Six cluster signs of MDR-TB were determined by PCA: nodules, infiltration, consolidation, cavities, destroyed lung and non-active lesions. Nine months after treatment, the area under the ROC curve (AUC) of MDR-TB patients with a cavity sign cluster was 0.818 (95% CI: 0.733–0.886), and the positive predictive value (PPV) and negative predictive value (NPV) of the treatment outcome were 79.6% (95% CI: 65.7–89.8%) and 72.9% (95% CI: 59.7–83.6%), respectively.Conclusion: PCA plays an important role in the classification of sign groups on pulmonary CT images of MDR-TB patients, and the sign clusters obtained from PCA are of great significance in predicting the treatment outcome.