Smear-positive Pulmonary Tuberculosis Patients Research Articles

Effectiveness of a case management model in newly treated smear-positive pulmonary tuberculosis patients.

To investigate the effectiveness of the case management mode on the application of smear-positive pulmonary tuberculosis patients. This was a randomized control trial. A total of 70 newly diagnosed smear-positive pulmonary tuberculosis patients were recruited and been randomly divided into experimental group and control group, with 35 participants in each group. In the experimental group, patients received the tuberculosis case management mode based on the conventional management mode. In the control group, patients received the routine management mode. We compared the knowledge, attitude, and practice score; sputum-negative conversion rate, effective imaging rate of the two groups at the time of initial admission, discharge, and one month after discharge. The results showed that there was no significant difference in baseline data between the two groups (p > 0.05); at the time of discharge and one month after discharge, the knowledge, belief, behavior, sputum-negative conversion rate, and imaging examination effective rate of the experimental group were higher than those of the control group (p < 0.05). The case management mode can improve the knowledge, attitude, and practice level; sputum-negative conversion rate; and imaging efficiency of newly treated smear-positive pulmonary tuberculosis patients.

P6‐67: Study on sputum non‐conversion at the end of intensive phase in smear positive pulmonary tuberculosis patients

P6‐67: Study on sputum non‐conversion at the end of intensive phase in smear positive pulmonary tuberculosis patients

Examination of close contacts of smear positive tuberculosis patients in Shaanxi, 2012–2020

Objective To analyze the examination of close contacts of smear positive pulmonary tuberculosis (TB) patients and the detection of pulmonary TB patients in Shaanxi province. Methods The performance of screening of 190 542 close contacts of newly registered smear positive pulmonary TB patients in Shaanxi from 2012 to 2020 was analyzed. The relevant information of the close contacts were collected and input into Excel database. SPSS 21.0 was used for data analysis. Results The screening rate and examination rate of the close contacts of smear positive pulmonary TB patients in Shaanxi were 99.89% and 84.92%. The detection rate of TB patients and smear positive TB patients were 1.56% and 0.03%. The examination rate of close contacts, the annual detection rate of TB patients and the detection rate of smear positive TB patients showed an overall upward trend. The detection rate in family members, symptomatic patients were higher than that in non-family members and asymptomatic patients. The differences in the examination rate, detection rate of TB patients and detection rate of smear positive TB patients among all groups were significant. Conclusion It is important to conduct early detection of TB in close contacts of newly registered smear positive TB patients.

Prevalence and risk factors associated with latent tuberculosis infection among household contacts of smear positive pulmonary tuberculosis patients in South India.

We aimed to determine the prevalence and find the risk factors associated with latent tuberculosis infection (LTBI) among the household contacts (HHC) of pulmonary TB patients. This cohort study was conducted from 2014 to 2019. Pretested standardised questionnaires and tools were used for data collection. The prevalence of LTBI among HHCs of TB patients was summarised as proportion with 95% confidence interval (CI). Mixed-effects generalised linear modelling function (meglm) in STATA with family Poisson and log link was performed to find the factors associated with LTBI. In total, 1523 HHC of pulmonary TB patients were included in the study. Almost all HHC shared their residence with the index case (IC) for more than a year; 25% shared the same bed with the IC. The prevalence of LTBI among the HHC of TB patients was 52.6% (95% CI: 50.1-55.1%). In an adjusted model, we found that among HHC belonging to the age group of 19-64years (aIRR=1.2; 95% CI: 1.1-1.3; p-value: 0.02), to the age group >65years (aIRR=1.4, 95% CI: 1.1-1.9, p-value: 0.02) and sharing the same bed with the IC (aIRR=1.2, 95% CI: 1.1-1.3, p value: 0.04) were independent determinants of LTBI among the HHC. One in two household contacts of TB patients have latent tuberculosis infection. This underscores the need of targeted contact screening strategies, effective contact tracing and testing using standardised methods in high TB burden settings.

English

BACKGROUND Sputum smear conversion is the negative conversion of the sputum smear at the end of the second month of treatment regimen under the National Tuberculosis Elimination Program (NTEP). When the acid-fast bacillus (AFB) smear comes negative at the end of an intensive phase, the treatment regimen can shift to the continuation phase that indicates bacillary load is a minimum. Although some authors consider the conversion of cultures when the AFB smear is negative, two potent drugs in the continuation phase are sufficient to kill the remaining bacilli. The drug that can kill bacteria in the first 2 days of treatment is called early bactericidal activity (EBA). This can be assessed by the percentage of negative conversion of cultures at the end of the intensive phase of the treatment regimen. EBA is very essential because it reduces the transmission in the community and chances of patient death. When the purpose is to kill as many bacilli as possible in the first few days and weeks of treatment, it is very important to include bactericidal drugs in the treatment regimen so that it reduces the chances of patient death and infectiousness and the negative conversion of the cultures after 2-month treatment regimen is an indication of the bactericidal capacity of the drug. The purpose of this study was to compare sputum smear conversion in daily versus intermittent treatment regimens in diagnosed cases of new sputum smear-positive pulmonary tuberculosis patients. METHODS This retrospective observational study was carried out in the Department of Respiratory medicine and nodal drug resistance tuberculosis centre (DR-TB) at the Government medical college and hospital, Akola. In this study, a total of 120 new patients were taken. 60 patients were given daily and intermittent regimens respectively under NTEP. RESULTS Out of 120 patients, 56 (93.33 %) patients in intermittent and 53 (88.33 %) patients in daily regimen were sputum smear-negative at the end of 2nd month (intensive phase) and at the end of 6th month (continuation phase). 1 patient (1.6 %) remained sputum smear-positive after the intensive phase. That patient was given 1 month of extension of anti-tuberculosis treatment (AKT) in the intensive phase and the patient became sputum negative after 1 month of extension. CONCLUSIONS It was concluded in this study, daily regimens and intermittent regimens were equally effective in negative conversion of the sputum smear at the end of the intensive phase and the end of the continuation phase. Negative conversion of the sputum smear is quite important because the bacillary load will be so low at the end of 2nd month that reduces the chances of patient death and transmission in the community. KEY WORDS Pulmonary Tuberculosis (PTB), Drug-Resistant TB (DR-TB), National Tuberculosis Programme (NTP), Revised National TB Control Program (RNTCP), Intensive Phase (IP), continuation Phase (CP), National Tuberculosis Elimination Program (NTEP).

Study on serum zinc and copper levels in pulmonary tuberculosis patients before starting Directly Observed Treatment, Short-course

Background: Tuberculosis is a major public health concern throughout the world including Bangladesh. The prevalence of tuberculosis (TB) is increasing day by day. Around one-third of world population is infected with M. tuberculosis. Still pulmonary tuberculosis (PTB) remains one of the important causes of mortality throughout the world with economic burden. Objective: To evaluate levels of the serum zinc and serum copper in smear positive PTB patients before starting Directly Observed Treatment, Short-course (DOTs) therapy. Methods: This was a cross-sectional type of observational study. A total of 100 subjects were included in this study. Among them 50 were smear positive PTB patients denoted as case group and 50 were apparently healthy individuals denoted as control group. Biochemical tests were carried out in the department of biochemistry of Mymensingh Medical College, Mymensingh. All the statistical analyses were performed by using SPSS version 21. Results were evaluated by using Student’s t-test. Results: After careful evaluation there was significant decrease in serum zinc level along with significant increase in serum copper level among the case group when compared with the control group. The mean values of serum zinc level were 93.96±10.04 μg/dl and 72.84±7.73 μg/dl in control and case group respectively. Serum zinc level decreased significantly (p &lt;0.001) in PTB patients. The mean values of serum copper were 111.81±21.26 μg/dl and 125.99±27.93 μg/dl in control and case group respectively. There was significant (p &lt;0.001) rise of serum copper level in PTB patients. Mediscope 2021;8(2): 122-127

Prevalence and factors associated with diabetes mellitus among tuberculosis patients in South India—a cross-sectional analytical study

ObjectiveTo determine the prevalence and determinants of diabetes mellitus (DM) among tuberculosis (TB) patients and to assess the additional yield and number needed to screen (NNS) to obtain a newly...

Magnitude of Multidrug Resistance and Associated Factors of Pulmonary Tuberculosis Among Adult Smear Positive Patients in Eastern Ethiopia.

BackgroundIn Ethiopia, multidrug resistant tuberculosis is a major public health problem. However, information is scarce regarding MDR-TB and associated factors. ObjectiveThe study was aimed to assess the magnitude of multidrug resistance and associated factors of pulmonary tuberculosis among adult smear-positive patients in Harari regional state health facilities, eastern Ethiopia.MethodsA cross-sectional study was conducted among 395 adult smear-positive pulmonary tuberculosis patients attending health facilities from March to October 2019. Smear-positive sputum samples were collected from health facilities, and transported to Harari Health Research and Regional Laboratory, and tested for drug susceptibility using a line probe assay. Data were analyzed using Statistical Package for Social Sciences version 20. Bivariate and multivariable logistic regression analyses with 95% confidence intervals were carried out to identify factors associated with multidrug-resistant tuberculosis.ResultsThe overall magnitude of multidrug-resistant tuberculosis was 3.8% (15/395) (95% CI: 2.0–5.8%). Being male (AOR = 4.9; 95% CI: 1.16, 20.5), patients with a previous history of tuberculosis (AOR = 4.9; 95% CI: 1.5, 29.6), treatment failure (AOR = 8.5; 95% CI: 1.61, 45.3), treatment default (AOR = 10.38; 95% CI: 1.86, 58.0), human immunodeficiency virus co-infection (AOR = 9.83.95% CI: 3, 21, 30.1) and a previous history of contact with multidrug-resistant tuberculosis patients (AOR = 14.4; 95% CI: 3.1, 67.6) had higher odds of multidrug-resistant tuberculosis.ConclusionThe overall magnitude of multidrug-resistant tuberculosis was high. Strengthening the tuberculosis control program by giving special attention to HIV co-infected patients, treatment failure and default, previously infected patients as well as to those individuals who have a history of contact with multidrug-resistant tuberculosis infected patients .

Socio-clinico-radiological profile of smear-positive pulmonary tuberculosis patients in association with sputum conversion and baseline hsCRP levels.

Our was an observational follow-up study where the aim was to assess the baseline high-sensitivity C-reactive protein levels in 50 smear-positive pulmonary tuberculosis patients in association with socio-clinico-radiological profile and microbiological conversion. Smear and culture conversion of sputum samples at the end of intensive phase of anti-tubercular treatment were recorded. Baseline serum high-sensitivity C-reactive protein estimation was done by ELISA. Mean high-sensitivity C-reactive protein levels at baseline, smear/culture converted and delayed converters were 68.1 ± 22.2 mg/l, 66.7 ± 22.0 mg/l and 91.6 ± 6.7 mg/l, respectively; high-sensitivity C-reactive protein levels were significantly higher in delayed converters as compared to sputum converters. Significantly higher baseline high-sensitivity C-reactive protein levels were seen in patients with bilateral chest X-ray lesions, cavitations, evening rise of temperature, haemoptysis and dyspnoea as compared to those without these features. high-sensitivity C-reactive protein, being a non-specific inflammatory marker could be an adjunct tool for TB prognosis.

Baseline high sensitivity C-reactive protein levels in smear positive pulmonary tuberculosis patients and its association with smear and culture conversion

Baseline high sensitivity C-reactive protein levels in smear positive pulmonary tuberculosis patients and its association with smear and culture conversion

Determining the risk factors associated with delayed sputum conversion at the end of the intensive phase among tuberculosis patients.

In pulmonary tuberculosis (PTB), the sputum conversion rate at 2 months is frequently used to evaluate treatment outcomes and effectiveness of a TB control programme. The study aimed to estimate the rate of delayed sputum conversion and explore its predicting factors at the end of the intensive phase among smear-positive PTB (PTB +ve) patients. A 3-year retrospective study was conducted in the government hospital in Pulau Pinang from 2016 to 2018. During the study, a standardized, data collection form was used to collect data from the patient record. Patients aged over 18 years were recruited. Multivariable logistic regression analysis was used to identify significant independent variables associated with delayed sputum conversion. A total 1128 of PTB patients were recorded visiting the TB clinic, 736 (65.2%) were diagnosed as PTB +ve; of these, 606 (82.3%) PTB +ve had a record of sputum conversion at the end of the intensive phase. Age ≥ 50 years, blue-collar jobs, smoking, heavy bacillary load, relapsed and treatment interrupted were significantly (P < 0.05) associated with delayed sputum conversion. Delayed sputum conversion rate at the end of the intensive phase was 30.5%. The rate of sputum smear conversion in the intensive phase of treatment was independently associated with high sputum smear grading at diagnosis, relapsed and treatment interrupted categories, old age and blue-collar occupations.

Predictors of delayed sputum smear conversion among pulmonary tuberculosis patients in Kota Kinabalu, Malaysia: A retrospective cohort study.

Smear-positive pulmonary tuberculosis (SPPTB) is the major contributor to the spread of tuberculosis (TB) infection, and it creates high morbidity and mortality worldwide. The objective of this study was to determine the predictors of delayed sputum smear conversion at the end of the intensive phase of TB treatment in Kota Kinabalu, Malaysia.This retrospective study was conducted utilising data of SPPTB patients treated in 5 TB treatment centres located in Kota Kinabalu, Malaysia from 2013 to 2018. Pulmonary TB (PTB) patients included in the study were those who had at least completed the intensive phase of anti-TB treatment with sputum smear results at the end of the 2nd month of treatment. The factors associated with delayed sputum smear conversion were analyzed using multiple logistic regression analysis. Predictors of sputum smear conversion at the end of intensive phase were evaluated.A total of 2641 patients from the 2013 to 2018 periods were included in this study. One hundred eighty nine (7.2%) patients were identified as having delayed sputum smear conversion at the end of the intensive phase treatment. Factors of moderate (advanced odd ratio [aOR]: 1.7) and advanced (aOR: 2.7) chest X-ray findings at diagnosis, age range of >60 (aOR: 2.1), year of enrolment 2016 (aOR: 2.8), 2017 (aOR: 3.9), and 2018 (aOR: 2.8), smokers (aOR: 1.5), no directly observed treatment short-course (DOTS) supervisor (aOR: 6.9), non-Malaysian citizens (aOR: 1.5), and suburban home locations (aOR: 1.6) were associated with delayed sputum smear conversion at the end of the intensive phase of the treatment.To improve sputum smear conversion success rate, the early detection of PTB cases has to be fine-tuned so as to reduce late or severe case presentation during diagnosis. Efforts must also be in place to encourage PTB patients to quit smoking. The percentage of patients assigned with DOTS supervisors should be increased while at the same time ensuring that vulnerable groups such as those residing in suburban localities, the elderly and migrant TB patients are provided with proper follow-up treatment and management.

Vitamin D deficiency and Tuberculosis in Basrah: The Effect of Anti-tuberculosis Drugs

Background Low vitamin D levels had been reported to be associated with a wide range of health problems, one of them is tuberculosis. the aim is to estimate vitamin D serum concentration among patients with tuberculosis at baseline, 2 and 5 months after starting anti-tuberculosis treatment. Methods The study was carried out at the TB Center and College of Medicine in Basrah (Iraq), during the period from September 2018 to June 2019. Participants were newly diagnosed tuberculosis patients, and their matched apparently healthy controls. Total 25-hydroxy vitamin D in serum was estimated using chemiluminescent microparticle immunoassay. Calcium, phosphorus, alkaline phosphatase, parathyroid hormone, and others, were also measured. Results There were no statistically significant difference in the mean levels of vitamin D between tuberculosis patients at baseline (n=56) and control subjects (n=57). The prevalence of vitamin D deficiency was high in patients and their controls at baseline where more than 80% of them had a vitamin D level below 20 ng/ml. When patients were followed two months after starting anti-tuberculosis treatment, the mean serum vitamin D level was significantly lower than that at baseline. Despite the wide spread vitamin D deficiency among TB patients, all smear-positive pulmonary TB patients, except 3, had sputum conversion after 2 months of treatment. Conclusions The prevalence of vitamin D deficiency is high with no significant difference between tuberculosis patients at baseline and their matched normal controls. Vitamin D deficiency did not seem to affect the response of patients to anti-TB treatment.

Clinical audit of management of smear positive adult pulmonary tuberculosis in PR1 tuberculosis clinic, KK Bandar Miri.

Malaysian tuberculosis (TB) clinical practice guideline (CPG) standardises the management of TB to improve the quality of care for TB patients. Not all primary care providers adhere to this guideline, however. This audit aims to improve the management of smear positive adult pulmonary TB by identifying areas of concern and developing action plans. Data for the audit were gathered from August 2018 to August 2019 from medical records of diagnosed smear positive pulmonary TB patients. Patients were included based on inclusion and exclusion criteria. Forty-eight smear positive pulmonary TB patients were recruited. The majority of patients were male (54.2%) and Malay (33.2%). TB symptoms were assessed for 29.2% of patients at two weeks and then in 81.3% at one month, 97.9% at two months, 16.7% at three months, 95.8% at four months, 22.9% at five months and 95.8% at six months. Medication side effects were assessed at two weeks for only 2.1% of patients, then for 8.3% of patients at one month, 2.1% at two months and 0% at subsequent months. At diagnosis, 25% and 4.2% of patients had their visual acuity and colour vision, respectively, assessed. Only 6.3% of patients were referred to pre-pregnancy counselling. Weights were recorded for 87.5% of patients at diagnosis, then for 27.1% at two weeks, 81.3% at one month, 91.7% at two months, 77.1% at three months, 97.9% at four months, 79.2% at five months and 93.8% at six months. Baseline investigations and Mycobacterium tuberculosis culture and sensitivity were conducted for all patients, but only 81.3% of patients were traced. No patients were referred to pharmacy for medication counselling. This audit shows that there is a difference between current practice and the national guideline. There are some downfalls in management and proper documentation, so interventions should be carried out to improve those aspects.

Smear-positive pulmonary tuberculosis patients with previously abnormal chest radiographs: missed opportunities for early diagnosis.

It is vital to diagnose and treat pulmonary tuberculosis (PTB) early, in the interests of the patient and public health. At the Singapore Tuberculosis Control Unit (TBCU), it was not uncommon to discover abnormal chest radiographs (CXRs) predating their PTB diagnosis by months to years in the electronic medical records (EMRs) of sputum acid-fast bacilli smear-positive patients. Our study explored this observation. The EMRs of sputum smear-positive PTB patients treated at the TBCU from January to July 2014 were viewed for abnormal CXRs preceding their PTB diagnosis. Information in the EMRs pertaining to the indication for the CXRs, radiological reports (including whether the possibility of PTB was stated) and action taken was captured. Of the 254 sputum smear-positive patients, 108 had previous CXRs in their EMRs, of whom 39 (36.1%) had previous CXRs compatible with PTB. Most of these were performed in tertiary institutions and for reasons unrelated to PTB. No action was taken in response to these CXRs in 24 (61.5%) patients. 27 (69.2%) patients had abnormal CXRs dating back more than six months, with 12 (30.8%) dating back more than 30 months before the PTB diagnosis. Patients aged ≥ 55 years were significantly more likely to have previous CXRs that were compatible with PTB. PTB patients may be asymptomatic or have chronic indolent disease and remain undiagnosed for years. There is a need for vigilance within our healthcare system to seize opportunities for early diagnosis and treatment to prevent the spread of this infectious disease in Singapore.

Time and risk factors for death among smear-positive pulmonary tuberculosis patients in the Health District of commune VI of Bamako, Mali, 2016

BackgroundThe End Tuberculosis (TB) Strategy aims to achieve 90% reduction of deaths due to TB by 2030, compared with 2015. Mortality due to tuberculosis in Mali was 13 per 100,000 inhabitants in 2014 and 11 per 100,000 inhabitants in 2017. Risk factors for death are not known. The objective of this study was to determine the time and risk factors for death in pulmonary TB patients with positive microscopy.MethodsWe conducted a retrospective cohort study from October to December 2016 in Commune VI of Bamako. Smear positive cases pulmonary tuberculosis from 2011 to 2015 were included. We reviewed the treatment registers and collected sociodemographic, clinical, biological and therapeutic data. Median time to death and hazard ratio (HR) were estimated by the Kaplan-Meier method and a Cox regression model, respectively.ResultsIn total, we analysed 1362 smear positive cases of pulmonary TB including 104 (8%) HIV positive and 90 (7%) deaths. The mean age was 36 ± 13 years, the sex ratio of males to females was 2:1. Among the deaths, 48 (53%) occurred during the first 2 months of treatment. Age ≥ 45 years (HR 2.09 95% CI [1.35–3.23]), weight < 40 kg (HR 2.20 95% CI [1.89–5.42]), HIV unknown status (HR 1.96, 95% CI [1.04–3.67]) and HIV-positive (HR 7.10 95% CI [3.53–14.26]) were significantly associated with death.ConclusionsThe median time to death was 2 months from the start of treatment. Independent risk factors for death were age ≥ 45 years, weight < 40 kg, unknown and positive HIV status. We recommend close monitoring of patients over 45 years, HIV testing in those with unknown status, an adequate care for positive HIV status, as well as a nutritional support for those with weight below 40 kg during the intensive phase of TB treatment.

Sputum smear conversion and associated factors among smear-positive pulmonary tuberculosis patients in East Gojjam Zone, Northwest Ethiopia: a longitudinal study

BackgroundSputum smear conversion is a key indicator of treatment response and reduced infectivity among bacteriologically confirmed pulmonary tuberculosis (PTB) patients. This study aimed at estimating sputum smear conversion and identifying factors hindering sputum smear conversion among bacteriologically confirmed PTB cases in East Gojjam Zone, Northwest Ethiopia.MethodsA total of 282 bacteriologically confirmed PTB patients were followed for 22 weeks through weekly sputum smear examination. Due to the absence of sputum culture and rapid diagnostic services, sputum smear conversion evaluation was conducted microscopically using acid-fast-bacilli staining technique of sediments from a 5% sodium hypochlorite concentration technique. Data on socio-demographic, clinical profile and personal behavior variables were collected using a pretested interviewer-administered questionnaire. Various descriptive statistics including mean, median with interquartile range (IQR), and proportions were computed to describe study objectives. Factors of sputum smear conversion were identified by multivariable logistic regression analysis and statistical significance was determined at a p value < 0.05.ResultsOver half, 166 (59%) of bacteriologically confirmed PTB patients were males and 147 (52%) were rural dwellers. The mean age of respondents was 35 ± 5 SD years. About 88 (31.2%) of bacteriologically confirmed PTB patients had comorbidities, 102 (36.2%) faced stigma, and 54 (19%) history of cigarette smoking. The median sputum smear conversions during the intensive phase and 5th months of treatment follow up were 35 dyas (IQR: 21-56 days) and 53 days (IQR: 28-82 days), respectuvely. The majority, 85% (95% CI 76–93%) and 95% (95% CI 85–99%) of bacteriologically confirmed PTB patients underwent sputum smear conversion at the end of 2nd and 5th months of treatment, respectively. Poor knowledge on TB, being HIV positive, higher smear grading, having diabetes mellitus, undernutrition, cigarette smoking, facing societal stigma, and TB service delays were positively associated with the length of sputum smear conversion (p value < 0.05).ConclusionBased on this study, the median sputum smear conversion time was higher compared to TB program expectations and findings from former studies. The study also identified important factors associated with sputum smear conversion time. Improving health literacy of the community by revising the existing community awareness strategies is essential to enhance treatment adherence and lower infectiousness after treatment initiation.

Unsuccessful treatment outcome and associated factors among smear-positive pulmonary tuberculosis patients in Kepong district, Kuala Lumpur, Malaysia

PurposeThe purpose of this study was to assess tuberculosis (TB) treatment outcomes among new smear-positive pulmonary tuberculosis (PTB) patients and identify the risk factors of unsuccessful treatment outcomes in Kepong district, Kuala Lumpur, Malaysia.Design/methodology/approachA retrospective cohort study was conducted using registry-based data from the Tuberculosis Information System (TBIS) between 2014 and 2018. Simple random sampling was used to select 734 males and 380 females from the TBIS registry. Smear-positive PTB patient's sociodemographic, clinical and behavioral characteristics were extracted and analyzed. Logistic regression was used to find the possible independent risk factors for unsuccessful treatment outcomes.FindingsThe treatment success rate was 77.20% (n = 860) which was still below the target set by the WHO (&gt;90%). In total, 254 patients showed an unsuccessful treatment outcome: 106 died, 99 defaulted, 47 not evaluated and 2 showed treatment failure. Unsuccessful treatment outcome was significantly associated with older age, male gender, non-citizen, unemployment and being HIV positive.Originality/valueThe study focuses on all these contributing factors of unsuccessful treatment outcome for a better risk assessment and stratification of TB patients and identify effective surveillance and management strategies to strengthen the control programs of tuberculosis in Kepong district.

Diagnostic Performance of GeneChip for the Rapid Detection of Drug-Resistant Tuberculosis in Different Subgroups of Patients.

ObjectiveDrug-resistant tuberculosis (DR-TB) is a growing problem worldwide. The rapid drug susceptibility test (DST) of DR-TB enables the timely administration of a chemotherapy regimen that effectively treats DR-TB. GeneChip has been reported as a novel molecular diagnostic tool for rapid diagnosis but has limited data on the performance of subgroup patients with DR-TB. This study aims to assess the diagnostic value of GeneChip in patients with different sexes, ages, treatment histories, treatment outcomes, and places of residence.MethodsWe recruited newly registered sputum smear-positive pulmonary TB patients from January 2011 to September 2020 in Lianyungang City, Jiangsu Province, China. We applied both GeneChip and DST to measure drug resistance to rifampin (RIF) and isoniazid (INH). The kappa value, sensitivity, specificity, and agreement rate (AR) were calculated. We also applied a Classification and Regression Tree to explore factors related to the performance of GeneChip.ResultsWe observed that sex, age, treatment history, treatment outcomes, and drug resistance type were significantly associated with the performance of GeneChip. For RIF resistance, there was significant accordance in young patients (kappa: 0.79) and cases with the treatment failure outcome (kappa: 0.92). For multidrug resistance (MDR), there was significant accordance in young cases (kappa: 0.77). Compared with previously treated patients, the newly treated patients had a significantly higher AR in detecting RIF resistance (0.97 vs 0.92), INH resistance (0.95 vs 0.89), and MDR (0.98 vs 0.92). The overall sensitivity, specificity, AR and kappa value for the diagnosis of MDR-TB were 0.70 (95% CI: 0.63–0.70), 0.99 (95% CI: 0.98–0.99), 0.98 (95% CI: 0.97–0.98), and 0.72 (95% CI: 0.67–0.78), respectively.ConclusionWe observed a high concordance between GeneChip and DST among TB patients with different characteristics, indicating that GeneChip can be a potential alternative tool for rapid MDR-TB detection.

Comparative evaluation of nitrate reductase assay with conventional proportion method for isoniazid and rifampicin susceptibility testing in smear positive pulmonary tuberculosis patients

With the surge of multidrug-resistant tuberculosis (MDR-TB) strains there is an escalating need for precise and cost-effective methods for a precipitous diagnostic and drug susceptibility testing (DST), chiefly in resource limited countries where tuberculosis is endemic. To find out the susceptibility pattern of Isoniazid (INH) and Rifampicin (RMP) in smear positive cases of pulmonary TB at MMIMSR Mullana and to evaluate the sensitivity and specificity of nitrate reductase assay (NRA) with standard proportion method for INH and RMP susceptibility testing. A cross sectional test validation study was carried out at Mycobacteriology division in the Department of Microbiology on 100 smear positive sputum samples from pulmonary tuberculosis patients.In comparison with L.J proportion method, NRA showed sensitivity, specificity, PPV, NPV, accuracy of 100%, 98.64%, 87.50%, 100%, and 98.76% respectively for INH. The sensitivity, specificity, PPV, NPV, accuracy of NRA compared to PM for RMP was 100%, 97.33%, 75.00%, 100%, 97.53% respectively. Direct NRA is simple, easy to perform, prompt, reasonably less expensive, without requisite of expensive reagents and advanced instrumentation. It is highly specific and sensitive technique in the detection of drug resistant TB when tested in parallel with the proportion method. Therefore, NRA may be routinely employed in TB laboratories in developing countries for drug susceptibility testing of .