Primary MDR Research Articles

Molecular determinants of multidrug-resistant tuberculosis in Sierra Leone.

A substantial proportion of MDR-TB strains in Sierra Leone were resistant against all first line drugs; however this makes the all-oral-six-month BPaLM regimen or other 6-9 months all oral regimens still viable, mainly because there was no FQ resistance.Resistance to BDQ was detected, as well as RR, due to mutations outside of the hotspot region. While the prevalence of those resistances was low, it is still cause for concern and needs to be closely monitored.

The Frequency of Multidrug-Resistant Tuberculosis Patient who have History of Tuberculosis, HIV, and Diabetes Mellitus at Dr. Soetomo General Academic Hospital

Introduction: The main causes of MDR TB include interperson transmission and TB treatment failure. In addition to TB, HIV and diabetes mellitus may raise the risk of TB MDR. To determine the TB MDR risk factors, it's critical to understand the prevalence of TB MDR patients with TB, HIV, and diabetes mellitus histories.Methods: This study is an observational descriptive study with a retrospective design. The sample for this study was all patients from the TB and MDR-TB polyclinic at Dr. Soetomo General Academic Hospital, Surabaya, in January 2020–December 2020 who met the inclusion criteria. The data obtained were analyzed descriptively.Results: There were 72 patients who met the criteria: there were 26 patients who have a history of TB, 15 patients who only have a history of diabetes mellitus, 2 patients who only have a history of HIV, 27 patients who have a history of TB with diabetes mellitus, and 2 patients who have a history of TB with HIV.Conclusion: The data could support the theory of an association between MDR-TB with TB, HIV, and diabetes mellitus and increase the awareness of primary MDR TB cases with history of HIV and diabetes mellitus.

Prevalence of primary INH and Rifampicin resistance among treatment Naïve tuberculosis cases in tertiary care teaching hospital in Puducherry: A prospective cross-sectional study

India contributes to approximately one-third of total global tuberculosis (TB) and one-fourth of all Multi-Drug Resistant TB (MDR-TB) burden respectively. The First National drug resistance survey (2014-16) showed MDRTB rates of 6.19% overall and 2.14% in newly diagnosed TB cases. With the above problem of primary drug resistance among newly diagnosed tuberculosis cases, the present study was planned to find the prevalence of Isoniazid (INH) and Rifampicin resistance in the treatment naïve new tuberculosis cases.: Study design: Prospective, cross-sectional.: Treatment naive newly diagnosed pulmonary tuberculosis cases.: 125.: After informed written consent, Sputum samples were collected and subjected to culture in MGIT 960 and positive cultures were recorded and subjected to drug sensitivity testing for INH (0.1 μg/ml) and Rifampicin (1 μg/ml) and a parallel non-drug MGIT was run as a control.: Most cases were males and belonged to the 20-59 years age group. Isoniazid (INH) resistance was found in 7 out of 125 samples, none had resistance to rifampicin. None of the categorical variables or grading of smear were having any statistically significant correlation with INH resistance.: INH resistance was found to be low (5.6%) with negligible MDR in the current study. Regular and large studies are needed to quantify and tackle the problem of primary MDR TB.

Primary drug resistance of M. tuberculosis according to the Center of Excellence of the WHO Network of Supranational Reference Laboratories of the CTRI in 2016–2021

ntroduction. Culture research and testing of Mycobacterium tuberculosis (MBT) for drug susceptibility in the Russian Federation is carried out with uneven qual-ity, which distorts the idea of primary drug resistance (DR). Aim. To study the primary DR of MBT to the main combinations of anti-TB drugs for 2016–2021 according at the Center of Excellence of the WHO Supranational Reference Laboratories Network at the Central Tuber-culosis Research Institute. Methods. Data on drug sus-ceptability and frequency of resistance to the main com-binations of anti-TB drugs (in accordance with updated definitions) of MBT isolated before treatment were stud-ied in 966 new TB cases from 69 regions of the Russian Federation examined at the Center of Excellence of the WHO Supranational Reference Laboratories Network at the Central Tuberculosis Research Institute from 2016 to 2021. Results. The rate of any primary drug resistance to rifampicin was 46.2%; 95% CI [43.0–49.3], MDR — 45.8%; 95% CI [42.6–48.9], pre-XDR — 24.2%; 95% CI [21.5–27.0], XDR — 5.4%; 95% CI [3.3–8.0]. Over time, there was a decrease in primary MDR MBT from 48.7% in 2016 and 54.9% in 2017 to 36.8% in 2021. The frequency of pre-XDR did not change during the observation peri-od. There was a statistically significant increase in the incidence of primary XDR from 2.1%; 95% CI [0.4–11.1] in 2016 and 0.0% in 2017 to 11.0%; 95% CI [6.1–19.1] in 2021 (p=0.03). Conclusion. The rate of primary MBT drug resistance to the main anti-TB combinations, ac-cording to our study, significantly exceeds the overall figures for Russian Federation. This suggests that the situation with MDR, pre-XDR, and XDR tuberculosis in the Russian Federation is much more alarming than we see from the regular reports, while the quality of local microbiological diagnostics on is insufficient

PRIMARY DRUG RESISTANT TUBERCULOSIS - THE CONCERN!

Tuberculosis is an airborne infection caused by mycobacterium tuberculosis. About 480000 people worldwide developed MDR TB in 2015,additionally 1,00,00 developed resistance to rifampicin and needed MDR TB treatment.MDR TB burden largely falls on China, India & the Russian Federation - which together account for nearly half of the global cases. The proportion of DR-TB cases among new cases is 2-3% and that among previously treated cases is 12-17%. Aims and objectives: To find the incidence of primary MDR TB in a tertiary care center in Navi Mumbai.Materials & Methods: A retrospective study of Culture and sensitivity reports of 100 patients was conducted.All underwent smear examination for AFB by ZNCF method.AFB Gene Xpert (CB-NAAT) and AFB culture and drug sensitivity. Results- In our study we found primary MDR to be 10 % while an additional 1 % was resistant to INH alone. All patients were HIV negative. Conclusion-The high proportion of Primary MDR-TB found in our study compels us to suggest that modalities to diagnose primary drug resistance tuberculosis should be made available to all newly diagnosed TB patients, irrespective of HIV status.

ДИНАМИКА ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТИ ВОЗБУДИТЕЛЕЙ ТУБЕРКУЛЁЗА ВО ВРЕМЯ ПАНДЕМИИ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ В Г. ДУШАНБЕ: НЕОБХОДИМОСТЬ ПРИНЯТИЯ СРОЧНЫХ МЕР

Objective: To study the frequency and structure of primary and secondary drug resistance in M. tuberculosis (MTB) and risk factors for primary multidrug/rifampicin resistance (MDR/RR) in MTB before (Group I: 2018-2019) and during the COVID-19 pandemic (Group II: 2019-2020) in Dushanbe in patients with pulmonary tuberculosis (PTB). Methods: A cohort retrospective study included all patients with PTB tested for susceptibility to anti-tuberculosis drugs (ATD). Odds ratio (OR), 95% confidence interval (95% CI), and p-value were used to determine the significance of the association between frequency and drug susceptibility spectrum (DSS) in groups I and II; risk ratio (RR) was applied to assess a possible association between exposure and outcome. Results: The study included 559 newly diagnosed and 87 previously treated patients. Primary MDR/RR MTB was found in 21.1%, secondary – in 39.8% of patients: in group I, patients with primary MDR/RR MTB constituted 22.4%, secondary – 34.7%; in group II, the prevalence of secondary MDR/RR MTB was found to be three times higher than that of the primary resistance (OR=2.97; 95% CI=1.67-5.27, p<0.001) due to a decrease in the prevalence of primary MDR/RR MTB (19.5%) and an increase in the secondary MDR/RR MTB (47.4%). There was a statistically significant increase in the frequency of primary drug resistance to fluoroquinolones in group II compared with group I: OR=2.58 for levofloxacin (p=0.003) and OR=2.31 for moxifloxacin (p=0.027). An increase in primary MDR/RR MTB was found among healthcare workers in group II (RR=3.21; 95% CI=1.50-6.89; p=0.05), which was statistically significant in patients with diabetes mellitus in both groups: group I (RR=1.83; p=0.035) and group II (OR=2.68; p<0.001). Conclusion: The current high prevalence of primary and secondary MDR, the increase in monoresistance during the COVID-19 pandemic, and the association of MDR with employment in healthcare institutions raise concerns regarding the quality of implementation of tuberculosis (TB) infection control measures in Dushanbe. The increased frequency of resistance to fluoroquinolones requires immediate action to control their prescription. It is recommended to improve anti-TB standards among patients with diabetes mellitus. Keywords: Drug resistance, M. tuberculosis, risk factors for multidrug resistance, COVID-19.

<i>NAT2</i> gene polymorphism and development of multiple drug resistant tuberculosis in patients with HIV infection

The objective: to run the comparative study of frequencies of variants of polymorphic loci of NAT2 gene in the development of multiple drug resistant tuberculosis (MDR TB) and drug sensitive tuberculosis (DS TB) in patients with HIV infection. Subjects and Methods. 70 patients with TB/HIV co-infection at the age from 24 to 58 years old were examined when admitted to hospital. 54 (77.1%) patients were new cases, the remaining 16 cases underwent repeated treatment. MDR TB was diagnosed in 47 patients: 33 patients had primary MDR, and 14 patients suffered from acquired MDR. Drug susceptible tuberculosis was diagnosed in 23 patients. Allele-specific PCR was used for genotyping of patients by rs1208, rs1799930, and rs1799929 polymorphic loci of N-acetyltransferase-2 ( NAT2 ) gene. Results. A high probability of carriage of wild genotype of NAT2 Arg197Arg(G590G) and allele NAT2 Arg197(590G) was revealed in MDR TB( n = 70, OR = 3.63, p = 0.02 and OR = 2.24, p = 0.05, respectively) and it was found low in DS TB ( n = 70, OR = 0.28, p = 0.02 and OR = 0.45, p = 0.05, respectively). Among patients with acquired MDR TB ( n = 14), carriers of the wild genotype of NAT2 Arg197Arg(G590G) prevailed ( n = 11; 79%), of them 10 were chronic cases and 1 had a relapse. Among patients with DS TB ( n = 23), the carriage of the wild genotype of NAT2 Arg197Arg G590G was found in 35% of patients ( n = 8), of them 7 were new cases and 1 patient suffered from chronic tuberculosis. Carriage of a combination of three studied wild genotypes of NAT2 Lys268Lys(A803A) × NAT2 Arg197Arg(G590G) × NAT2 Leu161Leu(C481C) was more often recorded in secondary MDR TB. In secondary MDR TB, the risk of carriage of wild genotypes of NAT2 gene versus primary MDR TB turned out to be high among all cases of diagnosed MDR TB ( n = 43, OR = 6.67 [1.28-34.86], p = 0.0277 ) and in the entire sample ( n = 65, OR = 11.91 [2.32-61.11], p = 0.0039). Conclusion. The results of genotyping in patients with TB/HIV co-infection and secondary MDR TB are associated with the carriage of acombination of wild genotypes of gene NAT2 Lys268Lys(A803A) × NAT2 Arg197Arg(G590G) × NAT2 Leu161Leu(C481C) .

Overview of the epidemic situation on tuberculosis in Russian prisons in 2019

Monitoring the epidemic situation of tuberculosis in pri- sons is of great importance in the Russian and internation- al system of monitoring tuberculosis. Objective of the study : to monitor the epidemic situation of tuberculosis in Russian prisons. Methods. We used information from official statistics. Extensive and intensive indicators were calculated, regression analysis was used. Results. The in- dicator “The proportion of people diagnosed with active tuberculosis diagnosed for the first time in their lives in penitentiary institutions in the total number of patients di- agnosed with active tuberculosis for the first time in their lives” is being successfully met. In 2019 it was 7.3% with a target of 7.8%. The notification rate of new cases of tuber- culosis is declining at a faster rate in correctional facilities (to 465.0 per 100,000) and at a lower rate in pre-trial de- tention centers (to 1251.0 per 100,000). The decline in the notification rate of new cases of tuberculosis in pre-trial de- tention centers may slow due to COVID-19. There is a fur- ther decrease in the prevalence of tuberculosis (to 2,677.3 per 100,000) and TB mortality (to 7.0 per 100,000). The inci- dence of TB/HIV among people living with HIV decreased to 2506.0 per 100,000, while ART coverage increased to 59.5%. A strong inverse correlation was found between the incidence of tuberculosis in people living with HIV and their coverage of ART (r=-0.99). The prevalence of MDR-TB has not changed over the past 3 years, amounting to 684.0 per 100,000 in 2019 with an increase in primary MDR to 32.8%. Conclusion: the TB epidemic situation continues to improve, mainly in correctional facilities, less in pre-trial detention centers. The improvement in the epidemic situa- tion of tuberculosis with HIV infection is associated with an increase in the coverage of people living with HIV with ART. Two multidirectional processes ensure the lack of MDR-TB dynamics: a decrease in the incidence of tuberculosis, on the one hand, and an increase in primary multidrug resis- tance of MBT, on the other.

Multidrug-Resistant Bacteria Among Culture Isolates at University of Gondar, Specialized Referral Hospital, Northwest Ethiopia: a Five-Year Retrospective Study.

Updated information on multidrug-resistant bacteria is essential because multidrug-resistant bacteria are one of the most important current threats to public health and prevalence of multidrug-resistant bacteria varies from time to time. A large number of people die annually due to infections caused by multidrug-resistant pathogens, with millions more suffering from serious infectious complications. The aim of this study was to determine the rate of multidrug-resistant bacteria isolates among culture requested patients at University of Gondar Specialized Referral Hospital, Northwest Ethiopia. A hospital-based retrospective cross-sectional study was conducted on all culture-positive patients' results at University of Gondar Specialized Referral Hospital, Northwest Ethiopia. Of the 2,161 bacterial isolates, the overall prevalence of multidrug-resistant bacteria was 40.5% (876/ 2,161). The multidrug-resistance rate of Gram-negative bacteria was 52.4% (493/942) and Gram-positive bacteria was 31.4% (383/1,219). From all isolates, 22.3% (481/2,161) were from wound discharge followed by 19.57% (428/ 2,161) from blood and 18.14% (224/2,161) from urine. The predominant bacteria isolated were S. aureus (44.1% (952/2,161)) followed by E. coli (16.6% (359/2,161)), Klebsiella species (13.2% (179/2,161)), and Citrobacter (4% (86/2,161)). The isolates showed high levels of resistance to ampicillin (81.99% (692/844)), cotrimoxazole (66.62% (531/797)), and penicillin (62.66% (381/608)) and lower resistance to vancomycin (6.79% (46/677)), amikacin (20% (18/95)), and nitrofurantoin (20.90% (21/110)). Primary MDR isolates were Serratia species (83.3% (5/6)), Enterobacter species (66.7% (20/30)), Klebsiella pneumonia (65.3% (89/176)), and Enterococcus species (57.1% (8/14)). The majority of MDR isolates were from inpatients (58.6% (p-value < 0.0001)), males (53.77%), age group < 2 years (30.7%), and blood sample (25.22%). A higher level of resistance to ampicillin, cotrimoxazole, penicillin and lower level of resistance to vancomycin, amikacin, and tobramycin were detected. Slightly lower overall rates of multidrug-resistant bacteria are isolated and a higher resistance rate is observed on Serratia species, Enterobacter species, K. pneumonia, Enterococcus species, and E. coli. Hospital admission is highly associated with the isolation of multidrug-resistant bacteria. Hence patient hospital stay should be considered in the prevention of multidrug resistant bacterial infections.

English

English

Pengaruh Jintan Hitam (Nigella Sativa) pada Konversi Sputum dan IFN- γ Penderita Tuberkulosis Paru yang Mendapat OAT Kategori I pada Akhir Minggu Kedua Fase Intensif

Background: Primary resistance is the resistance that occurs in patients who have never received treatment OAT or had ever received treatment OAT is less than 1 month. The incidence of primary MDR in Central Java in 2006 2.07%. Extrapulmonary TB about 15-20% of all cases of TB, and TB lymphadenitis is the highest form (35% of all extrapulmonary TB). Patients with decreased immune systems (SLE) can increase the incidence of TB. Research in Spain get 6x higher TB incidence in patients with SLE. Case: We present the case of 19 year old woman SLE who received treatment for 11 months whose came with shortness of breath and chronic cough since 2 month prior to admission. In physical examination we found right and left submandibula lymphonodi enlargement as solid, slightly mobile nodule with diameter 3 cm. Chest X ray showed lung inflammation which suspicion of specific process and minimal left pleural effusion, and concluded as pulmonary TB. FNAB confirmed lymphadenitis TB with granulomatous inflammation. One of AFB result is positive and Gene Xpert is M.tb positive with rifampicin resistant that make this patient categorized as primary MDR TB with lymphadenitis TB. This patient received Pirazinamid 1500 mg, Ethambutol 800 mg, Kanamicin 750 mg, Levofloxacin 750 mg, Ethionamide 500 mg, Cicloserin 500 mg, and B6 100 mg. Conclusion: MDR TB in general occur in patients with a history of OAT previous TB (MDR TB secondary). Primary MDR TB with lymphadenitis tb is a rare case, but can occur on the condition that decreases the immune system, one of SLE. This involves multiple immune disorders caused by the use of long-term immunosuppressive therapy.

TB MDR Primer dengan Limfadenitis TB pada Wanita SLE

Background: Primary resistance is the resistance that occurs in patients who have never received treatment OAT or had ever received treatment OAT is less than 1 month. The incidence of primary MDR in Central Java in 2006 2.07%. Extrapulmonary TB about 15-20% of all cases of TB, and TB lymphadenitis is the highest form (35% of all extrapulmonary TB). Patients with decreased immune systems (SLE) can increase the incidence of TB. Research in Spain get 6x higher TB incidence in patients with SLE. Case: We present the case of 19 year old woman SLE who received treatment for 11 months whose came with shortness of breath and chronic cough since 2 month prior to admission. In physical examination we found right and left submandibula lymphonodi enlargement as solid, slightly mobile nodule with diameter 3 cm. Chest X ray showed lung inflammation which suspicion of specific process and minimal left pleural effusion, and concluded as pulmonary TB. FNAB confirmed lymphadenitis TB with granulomatous inflammation. One of AFB result is positive and Gene Xpert is MTB positive with rifampicin resistant that make this patient categorized as primary MDR TB with lymphadenitis TB. This patient received Pirazinamid 1500 mg, Ethambutol 800 mg, Kanamicin 750 mg, Levofloxacin 750 mg, Ethionamide 500 mg, Cicloserin 500 mg, and B6 100 mg. Conclusion: MDR TB in general occur in patients with a history of OAT previous TB (MDR TB secondary). Primary MDR TB with lymphadenitis tb is a rare case, but can occur on the condition that decreases the immune system, one of SLE. This involves multiple immune disorders caused by the use of long-term immunosuppressive therapy.

Clinico-radiological Difference between Primary and Secondary MDR Pulmonary Tuberculosis

Clinico-radiological Difference between Primary and Secondary MDR Pulmonary Tuberculosis

Multidrug-resistant tuberculosis (MDR-TB) strain infection in macaques results in high bacilli burdens in airways, driving broad innate/adaptive immune responses

Tuberculosis (TB) has become the most deadly infectious diseases due to epidemics of HIV/AIDS and multidrug-resistant/extensively drug-resistant TB (MDR-/XDR-TB). Although person-to-person transmission contributes to MDR-TB, it remains unknown whether infection with MDR strains resembles infection with drug-sensitive (DS) TB strains, manipulating limited or broad immune responses. To address these questions, macaques were infected with MDR strain V791 and a drug-sensitive Erdman strain of TB. MDR bacilli burdens in the airway were significantly higher than those of the Erdman control after pulmonary exposure. This productive MDR strain infection upregulated the expression of caspase 3 in macrophages/monocytes and induced appreciable innate-like effector responses of CD3-negative lymphocytes and Ag-specific γδ T-cell subsets. Concurrently, MDR strain infection induced broad immune responses of T-cell subpopulations producing Th1, Th17, Th22, and CTL cytokines. Furthermore, MDR bacilli, like the Erdman strain, were capable of inducing typical TB disease characterized by weight loss, lymphocytopenia, and severe TB lesions. For the first time, our results suggest that MDR-TB infection acts like DS to induce high bacterial burdens in the airway (transmission advantage), innate/adaptive immune responses, and disease processes. Because nonhuman primates are biologically closer to humans than other species, our data may provide useful information for predicting the effects of primary MDR strain infection after person-to-person transmission. The findings also support the hypothesis that a vaccine or host-directed adjunctive modality that is effective for drug-sensitive TB is likely to also impact MDR-TB.

МНОЖЕСТВЕННАЯ ЛЕКАРСТВЕННАЯ УСТОЙЧИВОСТЬ У ВПЕРВЫЕ ВЫЯВЛЕННЫХ БОЛЬНЫХ ТУБЕРКУЛЁЗОМ В РЕСПУБЛИКЕ САХА (ЯКУТИЯ)

Epidemiological process of tuberculosis (TB) in the Sakha Republic (Yakutia) has been characterized by growing incidence of M. tuberculosis (MTB) multidrug-resistance (MDR). This study aimed to explore the incidence of primary MDR in patients with pulmonary TBin Yakutia from 2011 to 2016. Rates of primary MDR (including extensively drug resistant (XDR) cases) incidence were analyzed in new patients with sputum- and/or culture-positive pulmonary TB for Yakutia, Yakutsk, rural regions of Yakutia, and 5 major territorial zones of Yakutia, through theyears 2011 to 2016. We observed an increase from 23 % to 25 % in the proportion of pulmonary TB among primary MDR cases in Yakutia, for the study period. In 2016, this proportion was 1.1 times higher than in Russia (23.4 %), but lower than in the Far East Federal District (25.7 %). In Yakutsk, the same proportion has increased by half (from 24.2 to 35.4 %); in rural regions, on the contrary, it decreased by half (from 21.9 to 14.9 %). Primary MDR percentages among new cases of pulmonary TB decreased in South Yakutia and West Yakutia zones (by factors of 6.7 and 1.6, respectively); same proportions in the Arctic and Central Yakutia zones changed insignificantly. In East Yakutia zone, no case of primary MdR was detected in 2016. XDR cases among new pulmonary TB cases were solitary in 2011, detected only in Yakutsk. During the study period, incidence of XDR among new pulmonary TB cases increased from 0.5 % to 1.7 %, and cases with primary XDR were detected in Yakutsk and Arctic zone.

ТУБЕРКУЛЁЗ С МНОЖЕСТВЕННОЙ И ШИРОКОЙ ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТЬЮ МИКОБАКТЕРИЙ ТУБЕРКУЛЁЗА В РОССИЙСКОЙ ФЕДЕРАЦИИ

Objective: To assess the epidemic situation in the Russian Federation on tuberculosis with multidrug-resistant and extensively drug-resistant (MDR, XDR) of the pathogen and the effectiveness of its treatment. Methods: The information on forms of official statistical observation of the Russian Federation for 2009-2017 was studied. The calculated indicators describing the reservoir of tuberculosis with MDR and XDR of the pathogen are calculated and analyzed the results of treatment. Results: In 2009-2017 in the civil healthcare, the proportion of tuberculosis patients tested for drug sensitivity increased from 70.9% to 92.6%. The share of tuberculosis patients with MDR increased from 37.3% to 58.4%. The number of patients and prevalence of tuberculosis with MDR stabilized at the level of 24.2-25.9 per 100 thousand of the population. Primary MDR increased from 16.0% to 28.2%. The share of tuberculosis cases with XDR among cases of tuberculosis with MDR is from 11% to 13%. The number of registered cases of tuberculosis with established or presumed resistance, at least to rifampicin, increased from 15,896 in 2011 to 24,367 in 2015, and the frequency of their successful treatment increased from 37.1% to 53.5%. The number of cases registered for treatment of tuberculosis with XDR has increased from 1318 in 2012 to 2614 in 2015, and the frequency of successful treatment has increased from 26.1% to 34.2%. In 2009-2017 an increase in the rate of abacillation of patients with tuberculosis with MDR from 12.9 to 26.2 per 100 average annual bacterial excreta. Conclusion: In the Russian Federation, there is a stabilization of the epidemic situation in tuberculosis with MDR, but the process of replacing sensitive strains of the pathogen with drug-resistant strains continues. The indicator of the frequency of detection of cases of tuberculosis with MDR of the pathogen in the Russian Federation is 91.5% in relation to the data of WHO experts. The increase in the proportion of successful treatment of patients with MDR and XDR tuberculosis is associated with providing patients with access to anti-tuberculosis drugs of the reserve series, improving the clinical management of patients, introducing new anti-tuberculosis drugs and treatment protocols, and improving the patient's motivation for treatment. Keywords: Tuberculosis, multiple drug resistance, extensively drug resistance, treatment outcomes

ТУБЕРКУЛЕЗ ЛЕГКИХ У ПАЦИЕНТОВ, ВЫЯВЛЕННЫЙ ВО ВРЕМЯ ПЕРИОДИЧЕСКИХ ОСМОТРОВ И ПРИ ОБРАЩЕНИИ В МЕДИЦИНСКИЕ ОРГАНИЗАЦИИ

In Russia tuberculosis patients are detected during preventive mass screening and by self referral to medical units with clinical signs of the disease. Goal of the study: to compare pulmonary tuberculosis patients detected during mass screening and by self referral to medical units with clinical signs of the disease. Materials and methods: Data about 446 pulmonary tuberculosis patients treated in Republican TB Dispensary of Saransk in 2012-2014 were retrieved from Rosttsat Forms no. 8 and 33 and Russian Ministry of Health Reporting Forms (Edict 50). Statistica software was used for data processing. Results. Among 446 pulmonary tuberculosis patients detected in 2012-2014, the part of those detected during mass screening made ¾ out of total number, and those detected by self-referral made ¼, however the latter group of patients was significantly more dangerous from epidemiological point of view, since among them the part of those with long period of the disease before treatment start was higher, the positive sputum tests were more often observed as well as pulmonary cavities and primary MDR compared to the patients detected during mass screening. The obtained results point out at the need to focus on mass screening in the targeted groups of population concentrated around sources of infection.

Multidrug-resistant tuberculosis in KwaZulu-Natal, South Africa: An overview of patients' reported knowledge and attitudes.

BackgroundThe incidence and prevalence of multidrug–resistant tuberculosis (MDR TB) in the province of KwaZulu-Natal, South Africa, are amongst the highest in the world. Previously, interventions have been largely biomedical based; however, there is growing opinion that interventions must include social aspects such as patient education and attitudes.MethodsThis observational study assessed the knowledge and attitudes of 380 patients diagnosed with MDR TB at a centralised MDR TB unit in Durban. Data were collected using a questionnaire that was distributed to every third patient attending the outpatient MDR TB clinic. Data were collected over an 8-week period and analysed descriptively.ResultsJust under half of the respondents had primary MDR TB. Most respondents were young, female unemployed and did not receive a social grant. Knowledge around diagnosis of MDR TB was generally adequate. There were important misconceptions about spread of the disease and duration of treatment. Most respondents received knowledge of MDR TB from healthcare workers. Some respondents received knowledge from friends, family and Sangomas and believed that the disease was caused by bewitchment or as a form of punishment.DiscussionThe need for strengthening the role of primary care physicians in promoting education and providing support is highlighted. Further study is needed to investigate the high rate of primary MDR TB and to identify the unique challenges faced by women who have MDR TB. Future research could include the possibility of involving traditional healers in a contextually sensitive MDR TB education, training and support programme.

Prevalence and Risk Factors of Primary Drug-Resistant Tuberculosis in China

ObjectiveTo investigate the prevalence of primary drug-resistant tuberculosis (TB) and associated risk factors in China. We also explored factors contributing to the transmission of multidrug-resistant tuberculosis (MDR-TB). MethodsA total of 2794 representative, Mycobacterium tuberculosis isolates from treatment-naive patients were subjected to drug susceptibility testing, and risk factors for drug-resistant TB were analyzed. We also analyzed MDR-TB strain sublineages, drug-resistance-conferring mutations, and risk factors associated with clustered primary MDR strains. ResultsAmong 2794 Mycobacterium tuberculosis isolates from treatment-naive patients, the prevalence of any resistance to first-line drugs was 33.2% and the prevalence of MDR-TB was 5.7%. We did not find any risk factors significantly associated with resistance to first-line drugs. The 93 primary MDR-TB isolates were classified into six sublineages, of which, 75 (80.6%) isolates were the RD105-deleted Beijing lineage. The largest sublineage included 65 (69.9%) isolates with concurrent deletions of RD105, RD207, and RD181. Twenty-nine (31.2%) primary MDR strains grouped in clusters; MDR isolates in clusters were more likely to have S531L rpoB mutation. ConclusionThis study indicates that primary drug-resistant TB and MDR-TB strains are prevalent in China, and multiple measures should be taken to address drug-resistant TB.

DEVELOPMENT OF MDR TB IN SHORT DURATION IN A PATIENT RECEIVING TREATMENT FOR SIMPLE TB: A CASE REPORT

AbstractMultidrug resistant (MDR) tuberculosis (TB) is becoming more cumbersome especially in developing countries. Already supportive infrastructures are weak as compared to disease burden. Numerous diagnostic techniques for early diagnosis of TB and MDR TB have brought incremental improvements however; the technical intricacies of these assays and their reliance on enthusiastic laboratory infrastructure have restricted their implementation, particularly in low resource and high burden settings. Recently introduced GeneXpert MTB / RIF assay simultaneously detects the presence of MTB, and its susceptibility to the important first line drug rifampicin. Aim of this report is to understand the role of physician in prompt diagnosis and its control in spread of MDR TB and conversion of normal TB to MDR TB using available resources. Watchfulness of physician is an important factor in treating TB patients and early diagnosis of MDR TB using available resources. A good skilled team work is necessary to locate such cases in early stages and pro-mpt treatment can save many lives and ultimately serve as a big barrier in spreading primary MDR TB.Keywords:MDR TB, Tuberculosis, Prompt Diagnosis, GeneXpert.