Primary Multidrug-resistant Tuberculosis Research Articles

FACTORS ASSOCIATED WITH THE OCCURRENCE OF PRIMARY MULTIDRUG-RESISTANT TUBERCULOSIS IN MEDAN

Background: Tuberculosis (TB) treatment failure may lead to multidrug-resistant tuberculosis (MDR-TB). This failure can be detrimental to patients, not only causing death, but can also be transmitted to others, and those who are infected directly fall into the category of MDR-TB so that it can be referred to as primary MDR-TB. MDR-TB is the biggest problem in the prevention and eradication of TB worldwide. MDR-TB is a type of Mycobacterium tuberculosis resistance to at least the first two TB drugs of choice, including Isoniazid and Rifampicin. Purpose: This study aimed to determine the association between education, contact history, and knowledge regarding the occurrence of primary MDR-TB. Methods: This study used a cross-sectional study conducted at Community Health Center in Medan from November 2021 to February 2022. A total of 47 TB patients were selected for this study through purposive sampling methods. The dependent variable was primary MDR-TB occurrence while the independent variables consisted of several characteristics, namely education, contact history, and knowledge. The data were analyzed using chi-square. Results: in this study, sex (p=0.56; PR=1.12; 95% CI= 0.30<1,12<4,14;) and education (p=0.40; PR=0.56; 95% CI= 0.14<0.56<2.19) was not associated, while age (p=0.02; PR=0.16; 95% CI=0.02<0.16<0.94), contact history (p<0.001; PR=7.94; 95% CI=2.11<7.94<29.83) and poor knowledge (p=0.01; PR=5.00; 95% CI= 1.31<5.00<18.96) were associated with an occurrence of primary MDR-TB. Conclusion: the prevalence of primary MDR-TB increases with age, contact history, and poor knowledge.

Epidemiology and Drug Resistance Patterns of Mycobacterium tuberculosis in High-Burden Area in Western Siberia, Russia

Russia is a high-burden area for multidrug-resistant tuberculosis (MDR-TB). Here, we studied the epidemiological situation and drug resistance patterns of Mycobacterium tuberculosis in the Omsk region in Western Siberia. M. tuberculosis isolates (n = 851) were recovered from newly diagnosed TB patients in 2021. The isolates were tested by bacteriological and molecular methods, and long-term epidemiological data were analyzed. The TB incidence dec, this is not variablereased from 93.9 in 2012 to 48.1 in 2021, per 100,000 population, but the primary MDR-TB rate increased from 19.2% to 26.4%. The destructive forms of tuberculosis accounted for 37.8% of all cases, while 35.5% of patients were smear-positive. Of all isolates tested, 55.2% were culture-positive, of which 94.5% were further tested for phenotypic drug resistance and associated mutations. More than half (53.4%) of isolates were drug-resistant, 13.9% were monoresistant and 67.9% were MDR. Among MDR isolates, 40.4% were pre-XDR, and 19.2% were XDR. The spectrum of drug resistance included second-line drugs (new-generation fluoroquinolones, linezolid), which significantly increase the risk of an adverse outcome in patients. In conclusion, our results highlight the critical importance of monitoring drug resistance in circulating M. tuberculosis strains emerging due to ineffective treatment and active transmission.

The dynamics of lethality by the progression of the pulmonary tuberculosis process of the new cases patients

Introduction. Mortality among tuberculosis patients, both nationally and globally, has decreased significantly in the last 10 years, but the current epidemiological situation in tuberculosis allows to predict a new rise in the endemic state of the disease due to the increase of TB/HIV coinfection and the resistant tuberculosis. 
 Material and methods. The patient’s reports were analyzed – new cases, deaths due to the progression of tuberculosis registered in the Municipal Clinical Hospital of Phthisiopneumology, Chisinau, in 2 periods: the 1st period – 2001-2003 and the 2nd period – 2018-2020. During both periods, 64 new cases died in the hospital due to the progression of tuberculosis. Statistical data processing was performed with the application of the Student (t) test, the data were considered statistically true when p<0.05.
 Results. In the first period, the age between 25-54 years (81.3%) predominated, in the second period between 45-65+ (73.5%) years of the deceased patients. In both periods, a high share of unemployed patients was found. In the 2nd period compared to the 1st period a severe form of disseminated tuberculosis was established – generalized tuberculosis that was not registered in the first period, the number of deaths with TB/HIV increased 6 times, 4.5 times – with stomach resection in anamnesis, 2 times – with diabetes, 1.5 times with chronic alcoholism. Primary multidrug-resistant tuberculosis was confirmed at 21.9%, extensively resistant tuberculosis – at 4.7% of deceased patients.
 Conclusions. In the second period, the majority of the patients new cases due to the progression of tuberculosis died of severe forms of tuberculosis – generalized, increased number of comorbidities (mainly HIV infection), the presence of a large number of cases with primary resistant tuberculosis.

Medical Care for Tuberculosis-HIV-Coinfected Patients in Russia with Respect to a Changeable Patients' Structure.

To date, tuberculosis (TB) remains the primary cause of mortality in human immunodeficiency virus (HIV) patients in Russia. Since the beginning of 2000, a sharp change in the HIV patients’ structure, to the main known risk factors for HIV infection has taken place in Russia. The transmission of HIV through injectable drug use has begun to decline significantly, giving way to the prevalence of sexual HIV transmission today. These changes may require adjustments to organizational approaches to anti-TB care and the treatment of HIV-positive patients. Our study is aimed at identifying changes in TB-HIV coinfection patients’ structures in 2019 compared to 2000. Based on the results obtained, our goal was to point out the parameters that need to be taken into account when developing approaches to improve the organization of TB control care for people with HIV infection. We have carried out a cross-sectional, retrospective, epidemiological study using government TB registry data from four regions in two federal districts of Russia in 2019. The case histories of 2265 patients from two regions with high HIV prevalence, which are part of the Siberian Federal District of Russia, and 89 patient histories from two regions of low HIV prevalence, which are part of the Central Federal District of Russia, were analyzed. We found that parenteral transmission (69.4%) remains the primary route of HIV transmission among the TB-HIV coinfected. The unemployed of working age without disability account for 80.2% of all coinfected people, while the formerly incarcerated account for 53.7% and the homeless account for 4.1%. Those with primary multidrug-resistant TB (MDR-TB) comprise 56.2% of HIV-TB patients. When comparing the incidence of coinfection with HIV among TB patients, statistically significant differences were obtained. Thus, the chances of coinfection increased by 4.33 times among people with active TB (95% CI: 2.31; 8.12), by 2.97 times among people with MDR-TB (95% CI: 1.66; 5.32), by 5.2 times in people with advanced processes in the lungs, including destruction, (95% CI: 2.78; 9.7), as well as by 10.3 times in the case of death within the first year after the TB diagnosis (95% CI: 2.99; 35.5). The absence of data for the presence of TB during preventive examination was accompanied by a decrease in the chances of detecting coinfection (OR 0.36; 95% CI: 0.2; 0.64). We have identified the probable causes of the high incidence of TB among HIV-infected: HIV-patient social maladaptation usually results in delayed medical care, leading to TB treatment regimen violations. Furthermore, self-administration of drugs triggers MDR-TB within this group. Healthcare providers should clearly explain to patients the critical importance of immediately seeking medical care when initial TB symptoms appear.

Primary Multi Drug Resistant Tuberculosis (MDR TB) Osteomyelitis in Sternum associated with Xeroderma Pigmentosa: A Case Report

Primary Multi Drug Resistant Tuberculosis (MDR TB) Osteomyelitis in Sternum associated with Xeroderma Pigmentosa: A Case Report

Diligence needed on treatment of primary multidrug-resistant pulmonary tuberculosis with concomitant COVID-19 infection.

Diligence needed on treatment of primary multidrug-resistant pulmonary tuberculosis with concomitant COVID-19 infection.

Comparison of Chest X-Ray Findings Between Primary and Secondary Multidrug Resistant Pulmonary Tuberculosis

Introduction: Radiological imaging has a key role in multidrug-resistant (MDR) pulmonary tuberculosis (TB) screening and diagnosis. However, new cases of MDR pulmonary TB are often overlooked; therefore, its transmission might continue before its diagnosis. The most widely used and affordable radiological modality is a chest radiograph. This study aims to describe the characteristics of primary and secondary MDR pulmonary TB chest x-ray findings for differential diagnosis.
 Methods: This study was an analytic observational study with a retrospective design. Researchers evaluated medical record data of primary and secondary MDR pulmonary TB patients who underwent chest x-ray examinations. The patient's chest x-rays were then evaluated. Evaluated variables were lung, pleural, and mediastinal abnormalities and severity category.
 Results: The most common chest x-ray finding in primary MDR pulmonary TB was consolidation (96.2%), which was mostly unilateral (52.0%), accompanied by cavities (71.2%), most of which were multiple (83.8%) with a moderate category of severity. The most common chest x-ray finding in secondary MDR pulmonary TB was consolidation (100%), which was mostly bilateral (60.4%), accompanied by cavities (80.2%), most of which were multiple (90.1%) with severe category of severity. Pleural thickening (47.5%) was also found.
 Conclusion: There was a significant difference between primary and secondary MDR pulmonary TB in terms of mild severity category, and pleural thickening. Mild severity category is mostly found in primary MDR-TB and pleural thickening is mostly found in secondary TB.

Comparison of Chest X-Ray Findings Between Primary and Secondary Multidrug Resistant Pulmonary Tuberculosis

Introduction: Radiological imaging has a key role in multidrug-resistant (MDR) pulmonary tuberculosis (TB) screening and diagnosis. However, new cases of MDR pulmonary TB are often overlooked; therefore, its transmission might continue before its diagnosis. The most widely used and affordable radiological modality is a chest radiograph. This study aims to describe the characteristics of primary and secondary MDR pulmonary TB chest x-ray findings for differential diagnosis.
 Methods: This study was an analytic observational study with a retrospective design. Researchers evaluated medical record data of primary and secondary MDR pulmonary TB patients who underwent chest x-ray examinations. The patient's chest x-rays were then evaluated. Evaluated variables were lung, pleural, and mediastinal abnormalities and severity category.
 Results: The most common chest x-ray finding in primary MDR pulmonary TB was consolidation (96.2%), which was mostly unilateral (52.0%), accompanied by cavities (71.2%), most of which were multiple (83.8%) with a moderate category of severity. The most common chest x-ray finding in secondary MDR pulmonary TB was consolidation (100%), which was mostly bilateral (60.4%), accompanied by cavities (80.2%), most of which were multiple (90.1%) with severe category of severity. Pleural thickening (47.5%) was also found.
 Conclusion: There was a significant difference between primary and secondary MDR pulmonary TB in terms of mild severity category, and pleural thickening. Mild severity category is mostly found in primary MDR-TB and pleural thickening is mostly found in secondary TB.

Multi-Resistant Tuberculosis in Western Algeria: about 36 Cases

Multi-drug resistant tuberculosis (MDR-TB) is defined by the loss of susceptibility of Mycobacterium tuberculosis complex strains to the two major anti-tuberculosis drugs: isoniazid (H) and Rifampicin (R). This resistance may be acquired or primary. The aim of our study was to describe the epidemiological, clinical, bacteriological and evolutionary profile of multi-resistant tuberculosis patients in Western Algeria. To do so, aretrospective analytical study, which included 36 patients, was carried out in the pneumo-phthisiology department (B) of the Oran University Hospital (West Algeria) from January 2010 to December 2014. Our result showed an average age of 33.7 years. The risk factors for MDR-TB highlighted were tobacco (n=12; 33.3%), alcoholism (n=1; 2.8%) and family history of MDR-TB (n=3; 8.33). Primary MDR-TB was present in 11.11% of cases and secondary MDR-TB in 88.89% of cases. There was resistance to H and R in 13.8% of cases (n=5); to H, R and Streptomycin (S) in 50% of cases (n=18); to H, R and Ethambutol (E) in 5.6% of cases (n=2). The percentage of patients who had lost the sensitivity of the Bacillus to the four first-line anti-tuberculosis drugs (H, R, S, and E) was 25% of all patients tested (n=9) and H, R, S, and Ofloxacin (O) in one case. Five patients died. The rate of primary resistance found in this study constitutes a threat to efforts to control MDR tuberculosis in Algeria. It is therefore important to update the results and assess the extent of the problem.

TB trends in the Russian Federation

To study the tuberculosis (TB) trends in the Russian Federation for 2010-2019 and 2020. Methods. The main epidemiological TB indicators, including TB-HIV co-infection and multidrugresistant tuberculosis (MDR-TB) for 2010-2019 and 2020 were calculated. Results. The estimate number of TB deaths in 2015-2020 went down by at least 58.7%. The absolute number of incident TB cases (new cases and relapses) decreased by 32.5% in 2015-2020. By quarter’s I-III of 2020, the rates of primary MDR-TB increased up to 33.7%. Since 2016, the incidence of TB and HIV co-infection has been stable. The prevalence of TB has been continuously decreasing, and during the past 2-3 years, a decrease in the prevalence of TB- HIV co-infection and MDR-TB was reported. Conclusion. Russia has achieved the interim results of the End TB Strategy 2020, as well as the level of TB incidence corresponding to the late Soviet time. The growth of MDR-TB rate shows the need to expand the introduction of innovative anti-tuberculosis drugs and to revise the regimens for prevention of latent TB infection.

Trends in primary multidrug-resistant tuberculosis in the State of Rio de Janeiro: a retrospective study conducted during 2000-2019.

INTRODUCTION: We analyzed the trends in primary multidrug-resistant tuberculosis (MDR-TB).METHODS: We performed a time series analysis of primary MDR-TB cases reported in the State of Rio de Janeiro (RJ) during 2000-2019. The annual percent change and the average annual percentage change (AAPC) were computed using joinpoint regression analysis. RESULTS: The percentage of cases increased from 7.69% in 2000 to 38.42% in 2018. We observed an upward trend during this period (AAPC = 9.4; 95% confidence interval 1.4-18.0, p < 0.001). CONCLUSIONS: The trend indicates the increasing occurrence of MDR-TB transmission sources in RJ during 2000-2019.

Primary and acquired multidrug-resistant tuberculosis: Predictive factors for unfavorable treatment outcomes in Rio de Janeiro, 2000-2016.

ABSTRACTObjectiveTo identify clinical and demographic factors associated with unfavorable treatment outcomes in patients with primary and acquired multidrug-resistant tuberculosis (MDR-TB) in Rio de Janeiro State.MethodsRetrospective cohort study using data on 2 269 MDR-TB cases in 2000–2016. Factors associated with unsuccessful, loss to follow-up, and death outcomes in patients with primary and acquired resistance were investigated with bivariate and multivariate regression.ResultsPrimary resistance was 14.7% among MDR-TB cases. The unfavorable outcomes proportion was 30.3% in the primary resistance group and 46.7% in the acquired resistance group. There were significant differences in demographic and clinical characteristics between the two groups. Proportionally, the group with primary resistance had more cases among women (46.4% vs. 33.5% in the acquired resistance group), Caucasians (47.3% and 34%), and those with ≥8 years of schooling (37.7% and 27.4%). Extensively drug-resistant TB patients had 12.2-fold higher odds of unsuccessful outcome than MDR-TB patients, and comorbidities had 2-fold higher odds in the primary resistance group. Extensively drug-resistant TB had 5.43-fold higher odds in the acquired MDR-TB group. Bilateral disease and <8 years of schooling were associated with unsuccessful outcome in both groups. Being an inmate had 8-fold higher odds of loss to follow-up in the primary resistance group. Culture conversion by the sixth month was a protective factor for all outcomes.ConclusionsPrimary resistance cases of MDR-TB constitute a different transmission reservoir, which is related to other chronic diseases associated with higher acquisition of TB. The poor results observed in Rio de Janeiro State can contribute to increasing the transmission of primary MDR-TB, thus favoring drug resistance.

Increasing Burden of Multidrug Resistant Tuberculosis in HIV Infected Individuals: A Systematic Review and Meta-Analysis

Background: The increasing burden of multidrug-resistant tuberculosis (MDR-TB) in HIV infected individuals is a serious threat to global tuberculosis control programs. The study aimed to summarize the available evidences on the association of HIV infection and the development of MDR-TB and, finally, to provide an up-to-datepooled estimate of risks. Methods: We searched on PubMed, Google Scholar, and ScienceDirect databases to select eligible studies for our systematic review and meta-analysis, published between January 1, 2010, and July 30,2019. Two sets of reviewers independently extracted data and assessed the methodological quality of the studies using the Newcastle-Ottawa Scale. Subgroup analysis was pre-specified to perform according to the continent, country, income level, study design, mean/median age, and type of MDR-TB. The random-effects model was used to obtain the pooled odds ratio of the crude association between HIV infection and MDR-TB with a 95% confidence interval. We investigated the potential publication bias by checking funnel plot asymmetry and using the Egger’s test. Moreover, we assessed the heterogeneity using Cochran’s Q test and the I2 statistic. Findings: We identified 1496 studies through a database search, and after subsequent elimination based on our eligibility criteria, we selected 47 articles, including 60,754 participants. The pooled odds ratio was 1.47 (95% CI= 1.19-1.81) with substantial heterogeneity (I2=80.49%), and there was no evidence of publication bias (p=0.13). Subgroup analysis revealed that the estimated pooled odds ratio for European countries (OR=2.31, 95% CI= 1.80-2.96, I2=32.26%) was higher than the other three continents (South American, Asia, and Africa). Further analysis showed that the effect estimate was higher for primary MDR-TB (OR=3.13, 95% CI= 1.59-6.13, I2=13.13%) with no heterogeneity among the studies. There was also a trend towards increased risk of MDR-TB for HIV patients of 40 years and older (OR=1.96, 95% CI= 1.41-2.73, I2=69.11%) and women HIV patients (OR=1.97, 95% CI 1.03-3.78, I2=80.35%). The MDR-TB is found to be significant in high burden of TB/HIV countries (OR=1.51, 95% CI= 1.18-1.92, I2=78.1%) and in high-income countries (OR=2.64, 95% CI= 2.01-3.48, I2=15.01%). Interpretation:The risk of MDR-TB increases significantly among HIV infected individuals from the last decade. The most considerable burden of MDR-TB in HIV individuals was found in Europe and the women HIV patients with age 40 years and older are most in the risk of MDR-TB. Funding Statement: The authors stated: There was a student seed fund for this study. The corresponding author had full access to all study data and the authorized person for the final submission of the paper for publication. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The protocol was registered with PROSPERO-CRD42019132752.

Drug resistance profile among multi-drug resistant tuberculosis patients at diagnosis and correlation with history of anti-tubercular treatment in a tertiary care center

Background: Drug Resistant Tuberculosis (DR-TB) is a major threat to the realization of the goal of a TB free world in the near future. It is important to study the reasons for the increasing number of such cases so that effective action can be taken to control this growing epidemic.Methods: Sputum from 36 patients diagnosed with acquired pulmonary Multidrug Resistant Tuberculosis (MDR-TB) were subjected to first- and second-line Drug Sensitivity Testing (DST) after liquid culture in mycobacterium growth Indicator Tube (MGIT). Primary MDR-TB cases were excluded. The relation of the drug sensitivity profile with the history of prior treatment taken was statistically analysed.Results: Majority of the patients had received appropriate treatment, and most had adhered to prescribed treatment. Among the 36 patients, 24(66.7%) were found to be Pre-Extensively Drug Resistant (Pre-XDR-TB) and 4(11.1%) were extensively drug resistant XDR-TB cases. Inappropriate prescription of fluoroquinolone (FQ) was found to be most common. Prior intake of any drug was not found to significantly affect subsequent resistance to that drug.Conclusions: Fluoroquinolone resistance is quite common in patients with DR-TB (66.7%). This study did not find the prior use of FQ or any other drug to significantly affect subsequent resistance to the drug. Primary drug resistance is thus a major concern. 11.1% patients were found to be XDR-TB cases. Hence DST for first- and second-line drugs should be done at the time of diagnosis to avoid failure of treatment with a predesigned regimen.

The effects of diabetes on tuberculosis treatment outcomes: an updated systematic review and meta-analysis.

BACKGROUND: Previous evidence synthesis has suggested diabetes mellitus (DM) worsens tuberculosis (TB) treatment outcomes. However, these reviews are limited by the number, robustness and conflicting results among the studies included. We conducted a systematic review to update earlier analyses and explore heterogeneity among studies.METHODS: MEDLINE, EMBASE, AIM, LILACS, IMEMR, IMSEAR and WPRIM were searched between 1 January 1980 and 23 July 2018 unrestricted by language or region. All cohort and case-control studies investigating the difference in TB treatment outcomes amongst TB-DM patients compared to those with TB alone were included. Two reviewers independently assessed titles, abstracts, and extracted data. Culture conversion at two/three months, all-cause mortality, treatment failure, relapse and multidrug-resistant TB (MDR-TB) were evaluated using random effects meta-analysis with generic inverse variance. Heterogeneity was explored using subgroup analyses and meta-regression.RESULTS: One hundred and four publications were identified. Sixty-four studies including 56 122 individuals with TB-DM and 243 035 with TB, reported on death. Some outcomes showed substantial heterogeneity between studies, which we could not fully explain, though confounding adjustment and country income level accounted for some of the differences. TB-DM patients had higher odds of death (OR 1.88, 95%CI 1.59-2.21) and relapse (OR 1.64, 95%CI 1.29-2.08) compared to TB patients. More limited evidence suggested TB-DM patients had double the risk of developing MDR-TB (OR 1.98, 95%CI 1.51-2.60).CONCLUSION: DM is associated with increased risks of poor TB treatment outcomes, particularly mortality, and may increase risk of developing primary MDR-TB. Cost-effectiveness of interventions to enhance TB-DM treatment should be assessed.

Primary bacillary resistance in multidrug-resistant tuberculosis and predictive factors associated with cure at a referral center in São Paulo, Brazil.

ABSTRACTObjective:To identify transmitted or primary resistance among cases of multidrug-resistant tuberculosis and predictive factors for cure in multidrug-resistant tuberculosis after the first treatment. Method:Descriptive study of a cohort from 2006 to 2010, in a reference unit of tuberculosis in São Paulo, Brazil. The data were obtained by the revision of medical records. Clinical criteria were used to classify transmitted and acquired resistance. Extended primary resistance was also defined, in this study, as cases initially treated with a standardized scheme, but with no therapeutic success, and the pre-treatment drug susceptibility test (DST) showed presence of resistance. Results:156 patients with multidrug-resistant tuberculosis and their respective sputum samples were eligible for the study. Only 7% of the patients were positive for the human immunodeficiency virus (HIV). Previous treatment occurred in 95% of the sample. The cure rate after the first treatment was 54%. The median bacteriological conversion time of those who healed was one month. Bacillary resistance was considered acquired resistance in 100 (64%) and transmitted resistance in 56 (36%). By logistic regression, patients who presented primary multidrug-resistant tuberculosis (odds ratio-OR = 6,29), without comorbidity (OR = 3,37) and with higher initial weight (OR = 1.04) were associated with cure after the first treatment. Conclusion:The early detection of bacillary resistance and appropriate treatment are in favor of healing. Thus, it is crucial to know exactly the primary resistance rate avoiding the use of inadequate treatments, amplification of bacillary resistance and its transmission.

Unusual presentation of Primary Multi Drug Resistant Tuberculosis in immunocompetent patient: Rapid radiological deterioration - A case report

Unusual presentation of Primary Multi Drug Resistant Tuberculosis in immunocompetent patient: Rapid radiological deterioration - A case report

Prevalence of Primary Pulmonary Multi-Drug Resistant Tuberculosis in and around Aligarh Region

Prevalence of Primary Pulmonary Multi-Drug Resistant Tuberculosis in and around Aligarh Region

Prevalence and first-line drug sensitivity trends of Mycobacterium tuberculosis at a tertiary center in North-East India

Setting Tuberculosis (TB) still remains one of the major health problems facing humans. India accounts for almost a quarter of TB cases worldwide. The scenario is worsening owing to multidrug resistant-tuberculosis (MDR-TB). Assessment of local prevalence rates and detection of MDR-TB are important to rationalize therapy and prevent spread of resistant strains in community. Objective The study was undertaken to understand drug sensitivity patterns of tubercle bacillus and assess resistance trends in Meghalaya. Designs Specimens were screened for acid-fast bacilli, decontaminated by N-acetyl cysteine–sodium hydroxide method, and subsequently inoculated onto Lowenstein–Jensen media. Characteristic growth was biochemically identified as TB bacillus. Drug sensitivity assessment to first-line anti-TB drugs was performed by proportion method and sensitivity patterns noted. Results Among 103 specimens received, 23 showed acid-fast bacilli. Male to female ratio was 3 : 2. Fourteen (13.6%) pure isolates of Mycobacterium spp. were obtained. Biochemically 10 isolates were confirmed as M. tuberculosis. Drug sensitivity profile revealed highest mono resistance to isoniazid and streptomycin. Two (20%) isolates were MDR. Conclusion The study gives a brief overview of the menace of TB in Meghalaya. The study results provide valuable information about presence of primary MDR-TB and provide basis for future larger field surveys.

Factors contributing to development of multidrug resistant tuberculosis

Background: Several factors have been identified in the causation of multidrug-resistant tuberculosis (MDR-TB). The most important is previous inadequate treatment. Other factors include coinfection with HIV, diabetes mellitus, socioeconomically deprived groups, intravenous drug abusers, and other immunocompromised states. This study was planned to find out contributing/associated factors for the development of MDR-TB, specifically patients related factors. Aims and Objectives: The present study was conducted among MDR-TB patients to get the information regarding sociodemographic profile, present and history of TB, problems faced during treatment, and drug resistance pattern. Materials and Methods: A prospective, cross-sectional study was undertaken in a tertiary care teaching hospital. A total of 50 cases were included in the study who fulfilled inclusion criteria. All information was collected by studying the patients’ treatment record and by personal interview of each of the study participants using case record form. Results: Middle age groups (21–30 years and 31–40 years) were most commonly affected with MDR-TB. It was found that 44% of patients were smoker, 34% of patients were alcoholic, and 36% of patients were addicted to tobacco chewing, and 96% of patients have a body mass index below the normal range. Most of the patients were from lower socioeconomic status - Class V followed by class. Most of the patients (44) are of secondary MDR-TB and while only 6 patients are of primary MDR-TB.. Out of 44 secondary cases of MDR-TB total, 16 cases are due to not completion of the treatment, the reasons were poor adherence, adverse drug reactions, and substance abuse, etc., four patients were living with HIV/AIDS, and 3 patients were suffering from diabetes mellitus. Conclusion: There are causative factors and several risk factors associated with the development of MDR-TB has been found in the study. The strategy must be planned for incorporation of these factors in deciding treatment of MDR-TB.