Smear-positive Samples Research Articles

Analysis of drug resistance mutations in pulmonary Mycobacterium tuberculosis isolates in the Southern coastal region of Andhra Pradesh, India

Purpose and objectivesDetection of drug resistance plays a crucial role in tuberculosis (TB) treatment and prevention of Mycobacterium tuberculosis (MTB) transmission. The aim of this study was to determine the levels and patterns of resistance of MTB isolates to two key anti-TB drugs (rifampicin, RIF and isoniazid, INH) and the type of mutations in drug resistance genes (rpoB, katG and inhA) of the isolates at the southern coastal region of Andhra Pradesh, India, using commercially available GenoType MTBDRplus assay under the Revised National TB Control Program. MethodsGenoType MTBDRplus assay was performed on 2859 sputum smear-positive samples and the mutations in the genes responsible for resistance (rpoB, katG and inhA) were analyzed. ResultsAmong the line probe assay (LPA) valid isolates (2894), 1990 (68.76%) were drug susceptible, 437 (15.13%) were INH monoresistant, 104 (3.59%) were RIF monoresistant, and 363 (12.54%) were multidrug resistant. Codon 531 of rpoB gene and codon 315 of katG gene were found to have the highest mutation frequency for RIF resistance (270/467; 57.81%) and INH resistance (501/800; 62.62%), respectively. The RIF resistant rpoB mutations observed in the samples were S531L (57.81%), H526Y (8.56%), D516V (6.42%), and H526D (6.20%). Mutations in inhA promoter were found in 24.75% INH resistant isolates with C15T being the most common (85.85%). The turnaround times of the LPA test were from 48 to72h. ConclusionThe frequency of mutations in MTB in the coastal region of Andhra Pradesh, India, is similar to that in retreatment cases from most settings, with close to 80% in rpoB codon 516, 526, and 531, and over 80% in codons katG 315 and/or inhA promoter. The increase in INH monoresistance underlines the need for greater enforcement of national TB control programs.

Importance of Detection of Isoniazid and Rifampicin Mono Drug Resistance and Determining Rate of MDR-TB in Smear Positive Sputum Samples from a Tertiary Care Hospital of West U.P. India

Importance of Detection of Isoniazid and Rifampicin Mono Drug Resistance and Determining Rate of MDR-TB in Smear Positive Sputum Samples from a Tertiary Care Hospital of West U.P. India

Role of cartridge -based nucleic acid amplification test (CBNAAT) for early diagnosis of pulmonary tuberculosis in HIV

Background: Pulmonary Tuberculosis (PTB) is the commonest opportunistic infection and leading cause of death among people living with HIV (PLHIV). The role of cartridge based nucleic acid amplification test (CBNAAT) has potential to diagnose PTB and rifampicin resistance within two hours in PLHIV is promising. Methodology: 100 PLHIV patients with age of >18years having signs and symptoms greater than or equal to two weeks of duration and / or Chest X-ray findings suggestive of pulmonary tuberculosis who are attending to the department of Pulmonary Medicine, Guntur Medical College, Guntur from November 2016 to October 2017 are included in the study. Sputum samples sent for CBNAAT, AFB stain. Positive samples of CBNAAT and AFB stain are sent for conventional culture. Results: Out of 100 sputum samples, 45 were positive in CBNAAT, and 16 were AFB smear positive. All these 16 smear positive samples have 100% sensitivity in CBNAAT. These positive samples (45) were sent for culture. In culture out of 16 smear positive samples 15 are culture positive 1 is culture negative, which is false positive in CBNAAT also. In culture out of 45 CB-NAAT positive samples 29 culture positive, 16 culture negative. Sensitivity, specificity, PPV, NPV of smear in sputum samples are 46.88%, 98.5%, 93.75%, 79.76%, while that of CB-NAAT are 90.6%, 76.47%, 64. 44%, 94.55% respectively. Primary rifampicin resistance was detected in 1 case (2.22%) in CBNAAT and culture. Conclusions: CBNAAT is a rapid, reliable tool with least bio-safety concern and requires minimally trained staff, is best alternative to conventional methods of tubercular diagnosis and detects rifampicin resistance simultaneously within 2 hours. Keywords: CBNAAT; Sputum; TB.

Molecular Detection of Rifampicin and Isoniazid Resistant Mycobacterium Tuberculosis and Their Associated Mutation Pattern From Smear Positive Sputum Samples From a Tertiary Care Centre of West U.P.

Molecular Detection of Rifampicin and Isoniazid Resistant Mycobacterium Tuberculosis and Their Associated Mutation Pattern From Smear Positive Sputum Samples From a Tertiary Care Centre of West U.P.

The Importance of investigating Mycobacterium bovis in clinical samples of human origin

Introduction: Tuberculosis is an infectious disease that still represents a major public health problem worldwide. It is one of the main causes of mortality in people with HIV. Objective: To identify the presence of M. bovis as an etiological agent of human tuberculosis in sputum smear positive samples using the test Genotype MTBC™. Materials and methods: We conducted a descriptive study, 88 sputum samples were submitted to the Grupo de Micobacterias of the Instituto Nacional de Salud between January and November, 2015. We used the conventional microbiological analysis and the molecular test Genotype MTBC™ to identify the M. tuberculosis complex species. Results: Sixty two (70.5%) were males; the most affected groups were those between 24 and 34 years old, those residing in the municipal seats and those affiliated to the subsidized health plans. In 50.0% (44) of the samples with a result in the species identification test, we detected M. tuberculosis. Conclusion: The highest burden of the disease was recorded among the male population in productive ages. The identification test for species of the complex showed all were M. tuberculosis. However, it is not possible to discard the presence of M. bovis in humans in Colombia. The differential identification of species should be done in risk groups and in areas where the circulation of this mycobacterium in cattle is known.

PO 8392 SPUTUMMYCOBACTERIUMLOAD AND CYTOKINES BIOMARKER OF STIMULATED WHOLE BLOOD CELLS IN SPUTUM SMEAR-NEGATIVE PULMONARY TUBERCULOSIS SUDANESE PATIENTS

BackgroundImprovement of the diagnosis of smear-negative pulmonary tuberculosis (PTB) patients and identification of possible immune factors associated with the negative result of sputum will enable early and accurate diagnosis of smear-negative PTB. This study aimed to measure theMycobacteriumload in sputum samples of smear-negative patients and identify cytokines markers associated with smear-negative active pulmonary tuberculosis.MethodsSputum and heparinised blood samples were collected from 40 smear-negative, 40 smear-positive PTB patients and 21 healthy controls. All sputum samples were analysed by direct ZN stain and conventional PCR to confirm the infection and characterise the bacteria. The load of bacteria in sputum samples was measured using real-time PCR. Blood samples were stimulated with sonicated MTB H37Rv. TH1 (TNF-α, IFN-γ, IL- 1β) and TH2 (IL-10) cytokines were measured using ELISA technique.ResultsEight patients were grade 3+, 23 were grade 2+, 9 were grade 1+ and 40 were negative on smear. 87.5% of smear-negative patients were positive by PCR. Smear-negative PTB patients produced high concentration of IFN-γ compared with smear-positive. IL-10 and TNF-α concentration were significantly lower in smear-negative compared with smear-positive. IL-1β was not significantly different between smear-negatives and smear-positives. Both smear-negative and smear-positive samples produced significantly high IL-10 and TNF-α cytokine compared with the healthy controls, while IFN-γ production was significantly lower in MTB patients. A highly significant correlation between MTB load and cytokines was detected. The mean concentration of IFN-γ was higher in stimulated blood samples of patients with lower bacterial load. In contrast, IL-10 and TNF-α concentration were higher in patients with high bacterial load. The TNF-α and IL-1β were good biomarkers for diagnosis of smear-negatives.ConclusionSmear-negative PTB produced high TH1 cytokine and low regulatory cytokine compared to smear-positive.

Feasibility and Performance of Loop-Mediated Isothermal Amplification Assay in the Diagnosis of Pulmonary Tuberculosis in Decentralized Settings in Eastern China.

Early diagnosis is essential for the control and prevention of tuberculosis (TB). The objective of this study was to investigate the feasibility and performance of loop-mediated isothermal amplification (LAMP) in the diagnosis of pulmonary TB in county-level microscopy centers in Qingdao, Eastern China. A total of 523 presumptive TB patients were consecutively recruited between July 2017 and April 2018, and 22 patients were excluded from the analysis. Of 102 culture-positive cases, TB-LAMP identified 91 cases, demonstrating a sensitivity of 89.2%. In comparison, the sensitivity of routine smear microscopy was 69.6% (71/102), which was significantly lower than that of TB-LAMP (P=0.001). In addition, TB-LAMP sensitivities in smear-positive and smear-negative samples were 98.6% and 67.7%, respectively. In conclusion, our data demonstrate that TB-LAMP outperforms conventional smear microscopy in TB diagnosis, which could be used as an alternative method for smear microscopy in resource-limited settings in China.

Evaluation of GeneXpert MTB/RIF Assay for Detection of Pulmonary Tuberculosis on Sputum Samples.

To analyse the diagnostic performance of MTB/RIF assay for the diagnosis of pulmonary tuberculosis and detection of rifampicin resistance using sputum samples. Observational cross-sectional study. Provincial TB Reference Laboratory (PTRL), Hayatabad Medical Complex, Peshawar, Pakistan, from January to October 2015. A total of 268 participants were consecutively enrolled in the study after meeting the inclusion criteria. Their sputum samples were collected and processed by N-acetyl-L-cysteine-sodium hydroxide (NALC-NaOH) method and GeneXpert MTB/RIF assay. This study determined the overall sensitivity and specificity of MTB/RIF assay, it was 92.4% (86/93) and 97.1% (138/142), respectively. The sensitivity was 98.4% (60/61) in culture proven smear positive samples, whilst sensitivity in culture proven smear negative samples was 93.7% (30/32), using culture as reference standard. GeneXpert MTB/RIF assay could greatly improve early diagnosis of PTB in smear negative cases as well as multidrug resistant tuberculosis.

Evaluation of thin-layered agar for Mycobacterium tuberculosis isolation and drug susceptibility testing

Tuberculosis (TB) is India's major public health problem. According to the WHO, India harbors the largest number of cases, and TB control remains a challenge in diagnosis, drug resistance, and treatment. We undertook this study to compare the isolation rates of Mycobacterium tuberculosis (MTB) in agar, egg-based media, incidence of multidrug-resistant (MDR), and extended drug resistance (XDR) in MTB. This study aimed to compare and evaluate thin-layered agar (TLA) for the cultivation and drug susceptibility pattern of MTB with the conventional egg-based Lowenstein-Jensen's (LJ) medium and to differentiate atypical Mycobacterium by incorporating para-nitrobenzoic acid (PNB) in the TLA medium. This cross-sectional study was conducted in Sri Ramachandra Medical College and Research Institute, Porur, Chennai. A total of 68 smear-positive samples were inoculated into TLA (Middle Brook 7H 11) and LJ media with and without antibiotics (rifampicin, isoniazid, and ofloxacin) simultaneously after decontamination by the modified Petroff's method. TLA with PNB was also used to differentiate the growth of nontuberculous mycobacterium (NTM). Incubation was done at 37°C, and reading was taken every 3rd day for 6 weeks in case of TLA and for 8 weeks in case of LJ medium. Out of the 68 samples, 64 (94.1%) grew in LJ, and the growth observed at the end of the 1st, 2nd, 3rd, 4th, 5th, and 6-10th weeks was 0, 12 (18.8%), 10 (15.6%), 14 (21.9%), 15 (23.4%), and 13 (20.3%), respectively. Similarly, in TLA, 65 (95.5%) samples were grown, among which 22 (33.8%) grew in the 1st week and the rest (43 [66.2%]) in the 2nd week. MDR and XDR were observed in 4 (5.8%) and 3 (4.4%) samples, respectively. Seven of them were NTM. TLA is a better medium, with time to positivity ranging from 1 to 2 weeks with drug susceptibility and the pattern is also comparable with LJ medium. Incorporation of PNB in TLA helps in differentiating NTM.

Assessments of Different Methods for Testing Heteroresistance to Rifampicin in Tubercle Bacillus.

This study was undertaken to compare the ability of four clinically used methods to detect the heteroresistance of the tubercle bacillus to Rifampicin (Rif). A total of 94 sputum smear-positive samples of re-treated tuberculosis (TB) patients were employed. Rif-resistant tubercle bacillus tests were carried out by four methods: Lowenstein-Jensen cultures (L-J), reverse transcription-polymerase chain reaction (RT-PCR), microscopic observation drug susceptibility (MODS), and high-resolution melting (HRM). The rates of detection of Rif-resistant bacteria by of L-J, RT-PCR, MODS, and HRM were 35.1% (33), 36.4% (35), 36.2% (34), and 16.0% (15), respectively. The rate of detection by RT-PCR was slightly higher than that of L-J and MODS (P > 0.05) and significantly higher than that of HRM (P < 0.01). The median detection time of L-J, RT-PCR, MODS, and HRM was 60 d, 1 d, 9 d, and 1 d, respectively. Smear-positive TB can be directly and rapidly detected using RT-PCR and MODS technologies. The positive rates of RT-PCR and MODS were not only highly consistent with that of L-J and remarkably higher than that of HRM, but also were obtained in a markedly shortened time. The combination of MODS and RT-PCR has a synergistic effect on the speed of detection of heteroresistance, which is of great value for the timely and accurate diagnosis, guiding the clinicians in formulating the optimal treatment of smear-positive pulmonary tuberculosis.

The Evaluation of the Speed-Oligo® Mycobacteria Assay for Identification of Mycobacterium spp. from Smear Positive and Negative Sputum Samples

The Evaluation of the Speed-Oligo® Mycobacteria Assay for Identification of Mycobacterium spp. from Smear Positive and Negative Sputum Samples

Direct Detection of Rifampin-Resistant Mycobacterium tuberculosis in Respiratory Specimens Using Quantamatrix Multiplexed Assay Platform (QMAP) System: A Multicenter Study in Korea.

Rapid and accurate detection of rifampin-resistant Mycobacterium tuberculosis (MTB) is of primary importance for infection control and selection of anti-tuberculosis drugs. The aim of this study was to evaluate the usefulness of a newly developed multiplexed, bead-based bioassay (Quantamatrix Multiplexed Assay Platform, QMAP) for the direct detection of rifampin-resistant MTB in respiratory specimens. A total of 400 respiratory specimens collected from patients with clinically suspected tuberculosis or non-tuberculous mycobacteria (NTM) infections were tested with the culture-based conventional Mycobacterium species identification and QMAP system. Among 400 specimens, 154 samples were evaluated using phenotypic anti-tuberculosis drug susceptibility test (DST) and the QMAP system for the detection of rifampin resistance. Detection agreement rate between the culture-based conventional identification and QMAP system for MTB and NTM according to acid-fast bacillus smear positivity was as follows: 97.0% (131/135) and 93.6% (88/94) in 229 smear-positive samples and 69.4% (25/36) and 73.0% (65/89) in 171 smear-negative samples. Based on culture as the gold standard, the overall sensitivity and specificity of the QMAP system for Mycobacterium identification were 87.3 and 97.8%, respectively. The categorical agreement rate between phenotypic DST and QMAP system for rifampin was as follows: complete agreement, 92.9% (143/154); very major error, 0%; and major error, 0.6% (1/154). The overall sensitivity of the QMAP system for the detection of rifampin resistance was 97.1% (34/35). The QMAP system is a useful screening method for the early diagnosis of tuberculosis and selection of anti-tuberculosis drug, as it may detect rifampin-resistant MTB directly from respiratory specimens.

Ausencia de infecciones asintomáticas de malaria en una región endémica de Honduras

Ha existido un progreso considerable en la lucha contra la malaria en el mundo. En Honduras encontramos una reducción de los casos de más de 17,000 a 3,564 en la última década. Para cumplir con las metas de eliminación de la malaria, las estrategias deben de considerar a todos los individuos infectados por malaria en las intervenciones, por lo que adquiere mayor valor los esfuerzos enfocados en identificar las infecciones asintomáticas. El presente estudio tiene como objetivo evaluar la prevalencia de casos de infección asintomática de malaria en 3 comunidades del municipio de Iriona, Colón, Honduras para enero del 2015. Se realizó un estudio descriptivo transversal, en las comunidades de Ciriboya, Punta Piedra y Cusuna, Colón durante enero del 2015. Mediante un muestreo aleatorio simple se incluyeron 145 participantes. Se realizó el diagnóstico de infección de malaria asintomática mediante gota gruesa, PCR convencional y PCR anidada. En el análisis microscópico no se detectaron muestras de gota gruesa positivas, resultando en una prevalencia de 0.00%. El abordaje molecular tampoco detectó infecciones. Los hallazgos de este estudio concuerdan con el patrón de estudios anteriores en Honduras y con el avance que se ha tenido contra la malaria en el país. La detección activa de casos es recomendada para intervenciones en lugares donde la transmisión de la malaria se ha reducido hasta niveles bajos, por lo que su implementación en Honduras debe de ser parte de la estrategia integral de los programas de eliminación.

Bilayered Medium for Rapid Isolation of Mycobacterium tuberculosis.

A bilayered medium (BLM) seemed to indicate a rapid recovery time from Mycobacterium tuberculosis (M. tuberculosis) for the patients in question, namely, 48 hours. Sputum specimens collected from 112 patients with clinically suspected pulmonary tuberculosis were subjected to Ziehl-Neelsen staining and inoculation on Löwenstein-Jensen medium (LJM) and BLM. BLM grew all the 36 (100%) smear positive samples, while LJM grew only 20 (55.5%). On the first 2 days of incubation, BLM grew M. tuberculosis colonies in 14 specimens and in 36 specimens after 3 to 6 days. From the seventh day until the end of the incubation period, BLM grew M. tuberculosis in only 9 specimens. The mean (SD) time for detection on BLM was 6 (5) days, whereas on LJM, it was 22 (12) days. BLM is more sensitive than LJM in positive and negative smears. It was also much faster than other methods in detecting the presence of M. tuberculosis.

Programmatic Impact of Implementing GeneXpert MTB/ RIF Assay for the Detection of Mycobacterium Tuberculosis in Respiratory Specimens from Pulmonary Tuberculosis Suspected Patients in Resource Limited Laboratory Settings of Eastern Nepal

Background:In Nepal, introduction of GeneXpert MTB/RIF assay (Xpert assay) as an initial confirmation test for tuberculosis (TB) has been considered to have impact as a significant decrease in number of clinically diagnosed pulmonary tuberculosis (PTB) cases than previous years. This study aims to find out the distribution profile of suspected tuberculosis cases according to patients age, gender, treatment history and HIV status as well as to evaluate the utility of the Xpert assay over conventional acid-fast bacilli (AFB) staining method for the proper diagnosis of M. Tuberculosis in respiratory specimens from the tuberculosis (TB) suspected patient samples. Methods:The prospective cross-sectional analytical study was conducted in National Anti-Tuberculosis Center (NATA) center- Biratnagar and Primary Healthcare Center (PHC) - Manglabare, Morang District, of eastern Nepal from January 2014 to August 2014. Laboratory investigation was done by conventional AFB staining followed by Xpert assay. Results:A total of 1549 sputum samples were initially analyzed. AFB staining resulted in 1441 AFB smear negative samples and 88 AFB smear positive samples, whereas 20 samples were directly processed for Xpert assay. The male: female smear positive ratio was 2.8:1 and was higher among age groups (21-40) years. Tuberculosis among HIV patients was found 22.22%. Xpert assay demonstrates that out of 1441 smear negative AFB cases, 258 were found to have TB positive, whereas out of 88 smears positive AFB cases 12 were found to have TB negative. The sensitivity of the Xpert assay in patients classified as AFB smear positive was found 85.4% and the specificity in smear negative patients was 81%. Conclusion:The study concluded that implementation of Gene Xpert MTB/RIF assay is a helpful tool for early and rapid detection of tuberculosis with greater sensitivity and specificity over traditional AFB staining techniques.

Performance of the TB-LAMP diagnostic assay in reference laboratories: Results from a multicentre study

ObjectiveTo evaluate the diagnostic performance of TB-LAMP, a manual molecular tuberculosis (TB) detection method, and provide comparison to the Xpert MTB/RIF assay. MethodsIn a large multicentre study, two sputum samples were collected from participants with TB symptoms in reference laboratories in Peru, South Africa, Brazil, and Vietnam. Each sample was tested with TB-LAMP. The reference standard consisted of four direct smears, four cultures, and clinical and radiological findings. Individuals negative on conventional tests were followed up after 8 weeks. The Xpert MTB/RIF assay was performed on fresh or frozen samples as a molecular test comparison. ResultsA total of 1036 adults with suspected TB were enrolled. Among 375 culture-confirmed TB cases with 750 sputum samples, TB-LAMP detected 75.6% (95% confidence interval (CI) 71.8–79.4%), including 97.9% (95% CI 96.4–99.4%) of smear-positive TB samples and 46.6% (95% CI 40.6–52.7%) of smear-negative TB samples. Specificity in 477 culture-negative participants not treated for TB (954 sputum samples) was 98.7% (95% CI 97.9–99.6%). TB-LAMP test results were indeterminate in 0.3% of cases. ConclusionsTB-LAMP detects nearly all smear-positive and half of smear-negative TB cases and has a high specificity when performed in reference laboratories. Performance was similar to the Xpert MTB/RIF assay.

Tuberculosis Recommendations for Solid Organ Transplant Recipients and Donors.

Tuberculosis Recommendations for Solid Organ Transplant Recipients and Donors.

Evaluation of Nitrate Reductase Assay for Early Detection of Multi and Extensively Drug Resistance Tuberculosis in our Setup.

To evaluate the performance of nitrate reductase assay on smear positive pulmonary specimens for detection of multi and extensively drug resistant tuberculosis simultaneously. Cross-sectional analytical study. Microbiology Department, Armed Forces Institute of Pathology, Rawalpindi from June to December 2016. Smear positive pulmonary samples were processed both by nitrate reductase method on Lowenstein Jenson medium and also inoculated on gold standard Bactec MGIT 960 TB system. All the specimens were first digested and decontaminated according to standard protocol before inoculation. Out of total 76 samples, three did not give color and, therefore, were excluded from the final data analysis. Among the remaining 73 samples, mycobacterial index was: 28 specimens were having 1+ (1-9 bacilli/100 fields), 26 samples were 2+ (1-9 bacilli/ field), and 19 samples were having 3+ index (>9 bacilli/field). The respective sensitivity and specificity were 84% and 100% for isoniazid (INH); 82% and 100% for rifampin (RIF); 67% and 100% for amikacin (AK); and both 100% for ofloxacin (OFX). Overall agreement in case of INH, RIF, AK, and OFX was 94.5%, 97.2%, 98.6% and100%, respectively. Overall average agreement was 97.5%. Nitrate reductase assay is a reliable, low cost and accurate method that can be used for early for diagnosis of multi and extensively drug resistant tuberculosis.

Use of Genotype MTBDRplus Assay for Diagnosis of Multidrug-Resistant Tuberculosis in Nepal.

The main aims of this study were to study the patterns of mutations in rpoB, katG, and inhA genes in Mycobacterium tuberculosis strains isolated from patients from Nepal and to evaluate the performance of genotype MTBDRplus assay, taking conventional drug susceptibility testing as gold standard for diagnosis of MDR-TB. A total of 69 Mycobacterium tuberculosis strains isolated from 73 smear positive sputum samples from patients suspected of suffering from multidrug-resistant tuberculosis were used in our study. The drug susceptibility pattern of Mycobacterium tuberculosis isolated from these sputum specimens was determined by using genotype MTBDRplus assay taking conventional drug susceptibility testing as reference. The sensitivity and specificity of the genotype MTBDRplus assay for the detection of MDR-TB were found to be 88.7% and 100%, respectively. 88.7% of the rifampicin resistant isolates had mutations in rpoB gene. Similarly, 79.7% and 9.4% of isoniazid resistant isolates had mutations in katG and inhA genes, respectively. Genotype MTBDRplus assay was found to be very rapid and highly sensitive and specific method for diagnosis of MDR-TB and will be very helpful for early diagnosis of MDR-TB in high tuberculosis burden countries.

Drug adherence and efficacy of smear microscopy in the diagnosis of pulmonary tuberculosis after 2 months of medication in North-western Tanzania

ObjectivesThe study aimed at assessing the Tuberculosis (TB) medication adherence level and the efficacy of smear microscopy in the diagnosing pulmonary TB at month 2. MethodsA prospective study was conducted at the four sites located in the Northern-western Tanzania. New smear positive, pulmonary TB patients were followed up and their adherence to TB medication assessed after 2 months of the treatment. In addition, the acid fast bacilli (AFB) smear microscopy was performed after 2 and 5 months of the treatment. All smear positive samples were subjected to geneXpert (MTB/RIF) assay and culture on the Lowenstein Jensen (LJ) media. ResultsA total of 331 smear positive, newly diagnosed patients with pulmonary TB were enrolled. The median age was 36 [Interquartile range (IQR): 28–45] years and males formed the slightly majority, 187 (56.5%) of the participants. A total of 105 (31.7%) patients were infected with HIV. Out of 331 patients, 36 (10.9%) were still AFB smear positive at the end of two month. Of these 19 (52.8%) were positive on GeneXpert MTB RIF and none was Rifampicin resistant. Of note, only 13 (31.1%) were culture positive (viable). None of the patients was positive at month 5. Poor adherence to TB medications in the first 2 months of treatment was observed in 56/331 (16.9%) [95% CI=12.9–21.0] of the patients. ConclusionOver two thirds of smear positive patients are wrongly put in one month extension of the intensive phase treatment; this may cause increased costs and drug toxicity. Culture should be advocated to confirm smear positivity after 2 months of medications. TB treatment drug adherence in our setting is good and is associated with successful cure. No multidrug resistant tuberculosis (MDR-TB) was observed. Continued surveillance and emphasizing of TB drug adherence should be kept upbeat in order to control tuberculosis in developing countries.