MDR-TB Patients Research Articles

Multidrug-resistant tuberculosis in the Kharkiv Region, Ukraine.

OBJECTIVE: To document the level of drug resistance in MDR-TB patients and to characterize management capacities for their medical care and MDR-TB treatment outcomes in the Kharkiv region of Ukraine. This area has one of the highest frequencies of MDR-TB worldwide.METHODS: A retrospective observational cohort study was performed on registry data from the regional anti-TB dispensary in Kharkiv. All microbiologically confirmed MDR-TB patients registered in 2014 were included. Diagnostic, treatment and post-treatment follow-up data were analysed.RESULTS: Of 169 patients with MDR-TB, 55.0% had pre-extensively drug-resistant (pre-XDR) or XDR resistant patterns. Rapid molecular diagnosis by GeneXpert and liquid M. tuberculosis cultures were only available for 66.9% and 56.8% of patients, respectively. Phenotypic drug-susceptibility testing (DST) for high priority TB drugs (bedaquiline, linezolid, clofazimine) were not available. DST for later generation fluroquinolones was available only in 53.2% of patients. 50.9% of patients had less than 4 drugs in the treatment regimen proven to be effective by DST. More than 23.1% of patients with MDR-TB failed their treatment and only 45.0% achieved a cure.CONCLUSION: The high prevalence of MDR-TB and poor MDR-TB treatment outcomes in the Kharkiv region, is associated with substantial shortages in rapid molecular and phenotypic DST, a lack of high priority MDR-TB drugs, poor treatment monitoring and follow-up capacities.

Outcome of Multidrug Resistant Tuberculosis at a Tertiary Care Hospital, Rahim Yar Khan

Background. MDR TB is a major health problem. Proper counseling and education of DR-TB patients regarding adherence to therapy, monitoring side effects of treatment and controlling the comorbidities lead to better out come. Objective: To determine the outcome of MDR-TB at tertiary care hospital, Rahim Yar Khan. Methodology: This retrospective cohort study was carried out at Department of Pulmonology Sheikh Zayed Hospital, Rahim Yar Khan. A total of 231 patients of pulmonary MDR were included from May 2014 to December 2017 between the ages of 10 to 80 years of either sex. Extra pulmonary DR-TB, Poly drug resistant TB, XDR and patients on shorter regimen of DR –TB were excluded from the study. Treatment outcomes like cured, treatment complete, died, treatment failure and lost to follow up were defined according to WHO definitions. Data was then analyzed with SPSS version 22.0 Results: Out of 231 patients, 123 (57.1%) were males and 99 (42.9%) were females with mean age of 36.13+ 16 yrs. Regarding treatment outcome, 115 patients (49.8%) cured, 1 patient (0.4%) completed, 67 (29.0%) patients died, 5 (2.2%) patients showed treatment failure, 6 (2.6%) patients lost to follow up, 27 (11.7%) patents are still under treatment and treatment of 10 (4.3%) patients not valuated. Over all successful outcome (treatment completed and cured) was 50.2% while unsuccessful outcome (died, treatment failure, lost to follow up, painters still under treatment and treatment not evaluated) was 49.8%. Conclusion: The successful outcome was 50.2% among the pulmonary MDR-TB patients which is close to WHO target success rate i.e, 55%. Younger age groups showed significantly better outcome.

Improved treatment outcome of multidrug-resistant tuberculosis with the use of a rapid molecular test to detect drug resistance in China

ObjectivesNumerous studies investigate the advantages of rapid molecular drug susceptibility testing (DST) in comparison to phenotypic DST, but the clinical impact on treating multi/extensively drug resistant TB(M/XDR-TB) is less studied. Therefore, we examined how molecular DST testing may improve MDR-TB treatment management and outcome in Chinese settings. MethodsWe performed a comparative study of patient cohorts before and after the implementation of molecular DST diagnosis with Genotype MTBDRsl/MTBDRplus assay in two Chinese hospitals. We collected clinical information including time to sputum culture conversion and final treatment outcome. ResultsIn total, 242 MDR-TB patients were studied including 114 before (pre-implementation group) and 128 after the implementation (post-implementation group) of molecular DST. Time to MDR-TB diagnosis was significantly reduced for patients in the post-implementation group, as compared to the pre-implementation group (median,16 vs 62 days; P < 0.001). Patients with early available molecular DST results had a more rapid culture conversion (aHR1.94 95% CI: 1.37-2.73; median,12 vs 24 months, respectively; P < 0.001) and higher rate of treatment success (68% vs 47%, P < 0.01). ConclusionsThe use of molecular DST in routine care for MDR-TB diagnosis as compared to phenotypic DST was associated with a decreased time to culture conversion and improved treatment outcome, highlighting its important clinical value.

Correlation between the Duration of Ethambutol Therapy and the Toxic Optic Neuropathy Occurene in Patients with Multidrug-Ressistance Tuberculosis

Background: Tuberculosis affects one-third of the world’s population. Increasing number of tuberculosis cases also leads to the increase of anti-tuberculosis drugs use, such as ethambutol. Ethambutol is one of the most effective and rarely resistant tuberculosis drugs. Objective: To determine the relationship between duration of ethambutol therapy with toxic optic neuropathy in tuberculosis patients Method: This study enrolled MDR-TB patients who visited MDR-TB Unit of Dr. Soetomo General Hospital from July 2014 until the sufficient amount of sample was achieved. The patients enrolled are those who met the inclusion and exclusion criteria. Inclusion criteria consisted of MDR TB patients treated with ethambutol therapy, aged of 20-69 years old, and whose VEP examination results showed extension of P100 latency. Results: The mean of &lt;6 month duration was 3.24±1.348, while for the ?6 months was 11.71±5.764. This difference was statistically significant with p = 0.043. Conclusion: There is a correlation between duration of ethambutol therapy with toxic optic neuropathy in patients with MDR-TB.

Study on the prevalence of Beijing genotype Mycobacterium tuberculosis and its relationship with second-line anti-tuberculosis drug resistance

Objective: To explore the prevalence risk factors of Beijing genotype Mycobacterium tuberculosis (MTB) in Beijing and its correlation with second-line anti tuberculosis drug resistance. Methods: A total of 1 140 clinical MTB positive strains were collected from various districts in Beijing, and the drug sensitivity was detected by proportion method. Beijing genotype and non Beijing genotype MTB were identified by the method of Spoligotyping. Using SPSS 22.0 statistical software, chi square test or Fisher exact probability test was used to analyze the experimental data. Results: Among 1 140 MTB clinical isolates, 941 (82.5%) were Beijing genotype MTB, 199 were non Beijing genotype MTB. There were 663 males (70.5%) in Beijing genotype and 124 males (62.3%) in non Beijing genotype strains. There were significant differences in the proportion of males between the two genotypes [P=0.021, OR (95% CI):1.442 (1.048-1.985)]. There were 441 floating population (46.9%) in Beijing genotype MTB and 78 floating population (39.2%) in non Beijing genotype MTB. There was a significant difference in the proportion of floating population between the two genotypes [P=0.048,OR (95%CI):1.368(1.001-1.869)]. There were 129 patients (13.7%) aged 65 or older in Beijing genotype MTB, 40 patients (20.1%) aged 65 or older in non Beijing genotype MTB. The difference was statistically significant [P=0.021, or (95% CI): 0.631 (0.426-0.936)]. The resistance drug rates of Levofloxacin (Lfx), Amikacin (Am), Capreomycin (Cm), Para-aminosalicylic (PAS) in Beijing genotypes were 5.5% (52/941), 1.3% (12/941), 3.2% (30/941) and 3.0% (28/941), respectively, and those of non Beijing genotypes were 10.6% (21/199), 8.5% (17/199, 12.6% (25/199) and 11.6% (23/199), the difference was statistically significant (all P<0.05). There were 58 (6.2%) multidrug-resistant (MDR) strains in Beijing genotype MTB and 19 (9.5%) multidrug-resistant strains in non Beijing genotype. There was no significant difference in the proportion of MDR strains between Beijing genotype and non Beijing genotype (P>0.05). Conclusions: Beijing genotype MTB is widespread in Beijing and has a higher proportion in male population and floating population. Compared with non Beijing genotype, Beijing genotype MTB has a lower resistance rate to Lfx, Am, Cm and PAS, and there is no significant difference in the proportion of MDR-TB patients between the two genotypes.

Dynamic characteristics of drug resistant tuberculosis in Leiyang, Hunan, 2013–2017

ObjectiveTo analyze the dynamic trend of drug resistance of Mycobacterium tuberculosis in Leiyang city, Hunan province from 2013 to 2017, and to understand the local drug resistance spectrum of M. tuberculosis, so as to provide evidences for the formulation of chemotherapy regimen of tuberculosis (TB) and TB prevention and control. MethodsThe strains of M. tuberculosis collected in Leiyang from 2013 to 2017 were analyzed retrospectively. After identification by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS), all the M. tuberculosis strains were subjected to susceptibility tests of 8 first and second line anti-TB drugs by using microtiter plate method to understand the minimum inhibitory concentration. Statistical description and Chi-square for trend test were used to analyze the drug resistance trend. ResultsA total of 568 clinical strains of M. tuberculosis were included in this study, of which 18.49% (105/568) were from retreated TB cases, and 81.51% (463/568) form new TB cases. Overall, the drug resistance rate was 22.13% (120/568), the multi-drug resistance rate was 6.34% (36/568) and the extensively drug resistance rate was 0.35% (2/568). Drug resistance trend analysis showed that only the resistance rate to fluoroquinolones increased year by year (trend χ2＝8.585, P＝0.003), while the fluctuations of the drug resistance rate to other drugs, overall drug resistance rate and multi-drug resistance rate were not obvious, the differences were not statistically significant. ConclusionOverall, the drug resistance of tuberculosis in Leiyang was serious, the resistance rate to fluoroquinolones showed an increasing trend, and close attention should be paid on that. The standardized use of fluoroquinolones should be strengthened. Cross-drug resistance should be fully considered in the treatment of patients with drug resistant TB. In addition, the management of MDR-TB patients should be strengthened to reduce the incidence of primary drug resistant TB.

Treatment Adherence among MDR TB Patients in Nepal

Treatment Adherence among MDR TB Patients in Nepal

Rv2037c, a stress induced conserved hypothetical protein of Mycobacterium tuberculosis, is a phospholipase: Role in cell wall modulation and intracellular survival

The genome of Mycobacterium tuberculosis encode for several hypothetical proteins that needed to be characterized. Rv2037c, a hypothetical protein, was 25 and 4 folds upregulated under acidic and nutritive stress, respectively in M. tuberculosis H37Ra. The protein demonstrated lipolytic activity with pNP-decanoate with optimum pH 8.0 and temperature 40 °C. In addition, the protein demonstrated phospholipase activity. To understand the effect of rv2037c on mycobacterium physiology, the gene was cloned and expressed in M. smegmatis. The protein was found in membrane and extracellular fraction. The expression of rv2037c in M. smegmatis (MS_Rv2037c) altered colony morphology and cell surface features like enhanced biofilm and pellicle formation. MS_Rv2037c decreased cell-wall permeability, enhanced TDM content, resistance against various stresses and antibiotics. MS_Rv2037c demonstrated better infection and intracellular survival capability in infected THP-1 macrophage. Macrophages treated with Rv2037c demonstrated irregular cell membrane. Mice infected with MS_Rv2037c had higher bacterial load in lung, liver and spleen compared to control. Rv2037c induced the production of pro-inflammatory cytokines TNFα and IL12, suggesting its role in immune-modulation. Recombinant protein also generated humoral response in EPTB and MDR-TB patients. The results pointed towards the crucial role of this enzyme in cell-wall modulation, infection and intracellular survival of mycobacterium.

Decentralisation of MDR-TB care in rural South Africa: Overcoming the challenges through quality improvement

As the management of MDR-TB expands and is decentralised to resource-limited settings, ensuring that patients are managed in line with country guidelines optimises the chances of cure, and minimises transmission and development of further resistance. We aimed to develop sustainable quality MDR-TB services in a rural South African district hospital clinic. Four areas requiring improvement were identified: a poorly trained MDR-TB clinical team, recording of the nutritional status of patients, monitoring patients' response to treatment and drug side-effect monitoring. Changes were implemented over Plan-Do-Study-Act cycles over three months. Interventions included identifying and training nursing staff, creating a body mass index (BMI) measurement area, and introducing drug monitoring guidelines. Improvements were noted across all areas. The number of MDR-TB-trained clinic nurses increased over three months (from 20% to 90%). Increases were also seen in the proportion of patient BMIs recorded (0% to 87%) and of appropriate dietician referrals (0% to 75%). The proportion of smear results available, visual acuity tests and ECGs performed, prior to doctor review, increased over the 3-month period from 0% to 68%, 31% to 94%, and 75% to 89% respectively. Through multidisciplinary collaboration and iterative changes, it was possible to develop a strong clinical team and improve care of MDR-TB patients. Lessons learnt can be applied to similar challenges facing district hospitals caring for complex patients. • Quality improvement methodology improves MDR-TB care, despite limited resources • Multiple small iterative changes produce substantial improvements to clinical care

The burden of pre-extensively and extensively drug-resistant tuberculosis among MDR-TB patients in the Amhara region, Ethiopia.

BackgroundThe emergence of pre-extensively and extensively drug-resistant tuberculosis (Pre-XDR/XDR-TB) is the major hurdle for TB prevention and care programs especially in developing countries like Ethiopia. The less emphasis on universal access to laboratory techniques for the rapid diagnosis of TB and drug susceptibility testing (DST) makes the management of MDR-TB a challenge. Early detection of second line anti-TB drugs resistance is essential to reduce transmission of Pre-XDR/XDR-TB strains and adjusting the treatment regimen in MDR-TB.ObjectiveTo determine the prevalence and resistance pattern of Pre-XDR- and XDR-TB among MDR-TB patients in the Amhara region, Ethiopia.MethodsA cross sectional study was carried out in nine MDR-TB treatment centers in the Amhara region. Sputum samples were collected from all pulmonary rifampicin resistant (RR) or MDR-TB patients prior to anti-TB treatment. Lӧwenstein-Jensen (LJ) culture, Ziehl Neelsen (ZN) smear, MTBDRplus and MTBDRsl assays were performed according to the standard procedures. Data were analyzed using SPSS 20 software. Chi-square and/or Fishers exact test was employed.ResultsOverall, 6.3% of MDR-TB isolates were resistant to at least one second line drugs. Pre-XDR-TB and XDR-TB isolates accounted 5.7% and 0.6% respectively. Moreover, 3.4% were resistant to FQs and 3.4% were resistant to second line injectable drugs. All isolates were susceptible for low level kanamycin. Almost all pre-XDR-TB strains (90%) were previously treated with anti-TB drugs. Drug resistant Mycobacterium tuberculosis isolates were disproportionately distributed in districts of the Amhara region and the majorities were concentrated in urban areas.ConclusionsThe high proportion of MDR-TB patients resistant to at least one second line drug is alarming. Strengthening the laboratory facilities to monitor pre-XDR and XDR-TB patients is crucial. The TB programs need to give emphasis on the effective and rational use of second line drugs for newly diagnosed MDR-TB patients to prevent the emergence of pre-XDR/XDR-TB strains.

English

The extent and burden of MDR-TB varies significantly from country to country. In Africa, fewer than half of patients receiving therapy for multidrug-resistant TB (MDR TB) are successfully treated. Even though MDR-TB treatment was started in 2009 survival of MDR-TB treatment particularly of adverse treatment outcome is not studied in national level. Institution based retrospective cohort study was conducted at randomly selected four treatment Initiative Centers (TIC) & referral hospitals in Ethiopia. Data was collected using standardized checklist by trained professionals through reviewing records of all patients ever enrolled. Cox- proportional hazard regression model was built of the 494 records reviewed, 462 met the inclusion criteria. These patients were followed for 202250 person-day of observation; during the follow up period 38 (8.2%) patients were died making overall incidence density rate of 6.79 (95% CI=5.42-8.78) per 100 Person year. Survival at the end of 1st and 4th month was 98.2% and 92.3% respectively, while the overall mean survival time was 24.82(95%CI=22.8-25.72) months. Drugs side effect 3 (95 % CI [2.5-4.3, medical diagnosis other than TB 3.3 (95 % CI [1.7-5.6], HIV sero-status 2.7 (95 % CI [3.4-9.11] and bigger base line body were independently and significantly predicted mortality of MDR-TB patients. The incidence of death and treatment outcomes was in acceptable ranges, yet it needs due attention. Intervention to further reduce deaths has to focus on patients with co-morbidities, HIV, adverse effect and smaller base line body weight. Key words: 'MDR-TB, Survivable, Mortality, Ethiopia.

Analysis of IFN- And IL-10 Levels as Markers of Inflamation and Response Therapy of Anti-Tuberculosis in MDR Lung TB Patients

Multidrug-Resistant Tuberculosis (MDR TB) is caused by an organism that is resistant to at least isoniazid and rifampisin, the two most potent TB drug. Immune response to against Mycobacterum tuberculosis infection is related to the function of immunity. The function of interferon-γ (pro-inflammatory) is to activate macrophages, to stimulate antimicrobial molecules (to reactive oxygen species and nitric oxide), and to inhibits interleukin-10. Interleukin-10 function is to triggers humoral immunity, to inhibit IFN- γ. This study aimed to analyze level changes and the correlation with clinical data, also months of MDR TB patients who received standard OAT therapy. This was an observational study using cross sectional design. There were 29 patients who received standard MDR TB OAT therapy from 1-24 months, who met the inclusion criteria. Then, the patients were divided based on duration of the therapy, which are the initial/intensive and advanced phase. The initial phase divided into 2: first one is for 1-4 months therapy’s time (5 patients) and the second one is for more than 4-8 months (6 patients). Then, the advanced group divided into two groups again, which are third group with more than 8-16 months (13 patients) and fouth group with more than 16-24 months (5 patients). Then, measured serum concentration IFN-γ, IL-10 at the start of the study and 4 weeks later with the ELISA method. This research during the period July-December (6 months). IFN-γ post concentrations were decreased by 39.14 ± 139.12 pg/mL (p &gt; 0.05). The concentration of IL-10 was decreased by 33.93 ± 109.20pg/mL (p&gt;0.05). Based on the TB score bandim method during pre and posts results were 1 patient experienced severity change from severity class 1 to 2, 1 patient from severity class 2 to 1, 1 patient remained in severity 2 and 26 patient remained in severity 1. The results showed that serum IFN-γ and IL-10 levels in initial/intensive and advanced phase patients who received MDR TB regiment after four weeks did not changed.

SEVERITY OF TB CLASSIFIED BY MODIFIED BANDIM TB SCORING ASSOCIATES WITH THE SPECIFIC SEQUENCE OF ESXA GENES IN MDR-TB PATIENTS.

Background:The severity of pulmonary TB and detection of multidrug-resistant (MDR-TB) TB strains as potential causative agents could be crucial for the determination of treatment success. This study aimed to analyze the association between the specific sequences of the full esxA gene from MDR-TB sputum isolates and the severity class of MDR-TB patients.Material and Methods:A total of 98 sputum samples that were suspected to be MDR-TB were collected from Dr. Soetomo, Surabaya, Indonesia, from September to December 2016. A total of 24 isolates from the 98 patients were confirmed to have positive MDR-TB based on the GeneXpert test. MDR-TB isolates were tested using PCR targeting 580 bp encompassing the full esxA gene, and the resulting amplicon was sequenced. The severity class of the pulmonary TB patients was assessed using modified Bandim TB scoring.Results:The patient severity classification resulted in a moderate and severe degree of TB in 38% and a mild degree of TB in 63% of patients. Visualization of the PCR results showed that all MDR-TB samples were positive for the 580 bp band, and the sequence results showed 100% homology with that of the virulent wild-type M. tuberculosis H37Rv (NC_000962.3).Conclusions:In the current study, an association between the characteristics of the full esxA gene and the severity class of MDR-TB patients is yet to be found. However, the homologous sequence of all samples, associated with various degrees of disease severity, possess 100% identity with that of wild-type M. tuberculosis H37Rv.

Treatment Success Rate among Multi-Drug Resistant Tuberculosis Patients Registered Under Programmatic Management of Drug Resistant Tuberculosis Services in District Amritsar, Punjab, India

Background: MDR-TB has become an urgent public health problem worldwide, threatening the global TB control. The success rate of treating multi drug resistant remains very low. Method: This cross-sectional study was conducted on all MDR-TB patients who were registered and being treated under PMDT services in Amritsar district from 1st January 2015 to 31st December 2016. The treatment outcome with their clinico-demographic determinants was ascertained. Data management and analysis was done by using Microsoft excel and SPSS. Results: Out of 110 registered MDR-TB patients, 88 (80.0%) were males and 22 (20.0%) were females. The various treatment outcomes observed were- 36 (32.7%) cured, 20 (18.2%) treatment completed, 16 (14.5%) defaulted, 22 (20.0%) died, 11 (10.0%) regimen changed or shifted to XDR TB regime, 5(4.5%) transferred out. The success rate (cured + treatment completed) was 50.9%. Conclusions: On statistical analysis, it was observed that age (p=0.012), weight band of patients under RNTCP (p=0.040) were significantly associated with the treatment outcome. Other factors like sex, residence, type of tuberculosis and the HIV status of the patient did not affect the treatment outcome.

Auditory Evaluation with Pure Tone Audiometry and DPOAE in Kanamycin Treatment of Multidrug-Resistant Tuberculosis

Background: Kanamycin treatment is mainly used in multidrug-resistant tuberculosis (MDR-TB) patients. Hearing impairment associated along with the treatment leads to be permanently. Audiology assessments and monitoring may benefits to detect early on hearing loss. This study aimed to determine the evaluation of hearing alteration after kanamycin injection in the first month treatment. Method: We conducted a prospective study, observational longitudinal analytic with pre and post design in patients treated with kanamycin-based regimens in MDR-TB Outpatients Pulmonology Department Dr. Soetomo general hospital Surabaya. Assessment of hearing result using Pure Tone Audiometry and DPOAE, compared between baseline data and after 4 weeks treatments. Statistical analysis for hearing threshold and cochlear dysfunction based on overall frequency and specific frequency DPOAE examination, using Wilcoxon ranks test and Mc Nemar test. Results: A total of 15 patients (8 males and 7 females) with confirmed diagnosis of MDR-TB were included in this study conducted within 3 months in 2018. There were 15 ears represented with based line and compared to 4 weeks after treatment, showed on Audiometry and DPOAE on overall frequencies, found no significant difference (p &gt; 0.05), but in DPOAE at frequency of 10,000 Hertz (Hz) was found a significant difference (p = 0.002). Conclusion: DPOAE at high frequency (10,000 Hz) may benefits for early detection on hearing impairment. A baseline data with DPOAE is recommended, besides Audiometry for ototoxicity monitoring in Kanamycin treatment in MDRTB patients.

The impact of alcohol use on tuberculosis treatment outcomes: a systematic review and meta-analysis.

Alcohol use is associated with increased risk of developing tuberculosis (TB) disease, yet the impact of alcohol use on TB treatment outcomes has not been summarized. We aimed to quantitatively review evidence of the relationship between alcohol use and poor TB treatment outcomes. We conducted a systematic review of PubMed, EMBASE, and Web of Science (January 1980-May 2018). We categorized studies as having a high- or low-quality alcohol use definition and examined poor treatment outcomes individually and as two aggregated definitions (i.e., including or excluding loss to follow-up [LTFU]). We analyzed drug-susceptible (DS-) and multidrug-resistant (MDR-) TB studies separately. Our systematic review yielded 111 studies reporting alcohol use as a predictor of DS- and MDR-TB treatment outcomes. Alcohol use was associated with increased odds of poor treatment outcomes (i.e., death, treatment failure, and LTFU) in DS (OR 1.99, 95% CI 1.57-2.51) and MDR-TB studies (OR 2.00, 95% CI 1.73-2.32). This association persisted for aggregated poor treatment outcomes excluding LTFU, each individual poor outcome, and across sub-group and sensitivity analyses. Only 19% of studies used high-quality alcohol definitions. Alcohol use significantly increased the risk of poor treatment outcomes in both DS- and MDR-TB patients. This study highlights the need for improved assessment of alcohol use in TB outcomes research and potentially modified treatment guidelines for TB patients who consume alcohol.

Development of a Prognosis Nomogram of Treatment Outcomes for MDR-tuberculosis in Guinea (Conakry): A Retrospective Cohort Analysis

Despite the availability of the drug treatment for tuberculosis (TB) more than 75 years, mortality and drug resistance are increasing. Therefore, little data is available in Guinea. We aimed to develop and validate a prognosis nomogram of MDR-TB treatment outcomes. A retrospective cohort study was conducted among men and women, aged 18 years or older, with MDR-TB, from three major drug-resistance TB centres in Guinea. We used the logistic regression to analyse treatment outcomes. Prognostic factors with a p value less than 0.05 from a multivariate model were used to build nomogram and assessed their performance based on discriminative <i>c-index</i>, and calibration using the Hosmer-Lemeshow (H-L) test. To derive the optimal cut-off point score, the Youden’s index method was used. Among 232 patients with MDR-TB enrolled and followed between June 07, 2016 and June 22, 2018, 218 were analyzed. All patients were resistant to rifampicin, which diagnosed by the Xpert MTB/RIF. The overall rate of success was 73%. Factors associated with successful treatment in drug-resistant TB patients were higher BMI more than 18.5 kg/m² (p = 0.0253; aOR = 2.94), good adherence to treatment (p = < 0.0001; aOR = 33.92), normal platelets count (p = 0.0053; OR = 1.004), and the absence of clinical symptoms such as chest pain (p = 0.0083; aOR = 3.19) and depression (p = 0.0308; aOR = 8.62). The discrimination (<i>c-index</i> = 0.848 [95% bootstrap CI, 0.780 – 0.916] in the derivation sample and 0.803 after correction for optimism) and calibration (H-L_X² = 2.91 [p = 0.94]) were good. The optimal absolute risk threshold was 20%, corresponding to a sensibility of 95% and specificity of 58%. Treatment success outcomes was lower than those recommended by the World Health Organization (75%). We recommend to improve the MDR-TB patient monitoring during treatment, nutritional status, and considering the psychological state. Our prognosis nomogram needs to be validated in an external population before it can be used in clinical practice.

Intermittent treatment interruption and its effect on multidrug resistant tuberculosis treatment outcome in Ethiopia

Treatment interruption is one of the main risk factors of poor treatment outcome and occurrence of additional drug resistant tuberculosis. This study is a national retrospective cohort study with 10 years follow up period in MDR-TB patients in Ethiopia. We included 204 patients who had missed the treatment at least for one day over the course of the treatment (exposed group) and 203 patients who had never interrupted the treatment (unexposed group). We categorized treatment outcome into successful (cured or completed) and unsuccessful (lost to follow up, failed or died). We described treatment interruption by the length of time between interruptions, time to first interruption, total number of interruption episodes and percent of missed doses. We used Poisson regression model with robust standard error to determine the association between treatment interruption and outcome. 82% of the patients interrupted the treatment in the first six month of treatment period, and considerable proportion of patients demonstrated long intervals between two consecutive interruptions. Treatment interruption was significantly associated with unsuccessful treatment outcome (Adjusted Risk Ratio (ARR) = 1.9; 95% CI (1.4–2.6)). Early identification of patients at high risk of interruption is vital in improving successful treatment outcome.

Evaluation of Multi Drug Resistance Tuberculosis During the Study of Pulmonary TB in Telangana Population

Out of 89 adults (aged between 25 to 75 years old)of both sexes of pulmonary Tuberclosis 4 (4.4%) were multi drug TB patients detected. The 89 patients history was 24(26.9%) were Tobacco smokers,19(21.3%) had exposed to air-pollution, 11(12.3%) had high dosage of cortico steroids,6(6.7%) had haemodialysis, 7(7.8%) were diabetes mellitus, 8(8.9%) had alcohol use,5(5.6%) had chronic liver diseases, 9(10.1%) were HIV positive. Reasons for discontinuation of TB treatment was, 29(32.5%) had false sense of cure, 12(13.4%) had non-co-operation of paramedical staff, 11(12.3%) had domestic problems, 14(15.7%) had migrated for labor, 9(10.1%) cost of transport, 14(15.7%) had adverse drug reactions. The rate of resistance in single and poly drug therapy was. Rifampicin, pyrozinamide, ethambutol streptomycin had 0% rate resistance. Ioniazide + streptomycin, Isoniazide + streptomycin + rifampiain, Ethambutol + streptomycin had 0.5% resistance rate. Isonizide + Ethmubutol had 2.2% rate of resistance. Isonizide had 1.8% resistance. This study of pulmonary tuberculosis with MDRTB patients with different history and different rates of immunity will be quite useful to pulmonary medicine physician to treat such patients efficiently because pulmonary tuberculosis is one of the main causes of morbidity and mortality in India and abroad.

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.