Drug Susceptibility Patterns of Mycobacterium tuberculosis Isolates from Tuberculosis Patients in Coastal Kenya

Abstract

Background: Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis. Anti-tuberculosis drug resistance is an emerging health problem in Kenya and especially in Coastal region. This is a major challenge in tuberculosis control. Diagnosis is based on Ziel-Neelsen staining alone and patients are treated without information on sensitivity patterns.Aim: This study aimed to determine drug susceptibility patterns of Mycobacterium tuberculosis in Coastal Kenya. Study Design: Hospital and laboratory based cross-sectional study was carried between April 2015 and July 2016 at Coast General Referral hospital; Tudor, Port-Reitz, Likoni Sub-County hospitals; Mlaleo, Kongowea and Mikindani health centers. Methodology: Sputum samples from patients with bacteriological confirmed TB on microscopy were cultured on Lowenstein Jensen (LJ) media. Strains of MTB complex from Lowenstein Jensen (LJ) slopes were subjected to drug susceptibility testing (DST) to first-line drugs including isoniazid (H), rifampicin (R), streptomycin (S) and Ethambutol (E) using proportional method on the Mycobacterium Growth Indicator Tube (MGIT) conventional method. Participants were offered diagnostic testing and counselling for HIV testing. Results: Drug sensitivity test was performed for a total of 210 Mycobacterium tuberculosis isolates for the first line anti-TB drugs. About seventy eight percent and twenty nine percent of the strains from new patients and previously treated patients were fully sensitive to all the drugs tested respectively. Prevalence of any resistance to one drug was 102 (48.6%, 95% CI: 20.45 -28.23). Any single drug resistance was most frequent in isoniazid 30 (16.0%), Ethambutol 20 (10.0%), Streptomycin 18 (18.3%) and Rifampicin 4 (2.1%) in newly diagnosed patients. Among previously treated patients any resistance to streptomycin, ethambutol, isoniaziad and rifampicin was 10 (58.8%), 9 (52.9%), 7 (41.2%) and 4 (23.5%) respectively. Prevalence of MDR-TB defined as resistant to at least both isoniazid and rifampicin was 10 (4.8%) among new and previously treated patients respectively. Conclusion: The current study reveals that the overall resistance to first line anti-TB drugs was high. Although the rate of MDR-TB was relatively low, this signifies that conditions favouring the spread of MDR-TB are on high rise. Therefore, it is essential to address the problems of development of drug resistant strains of TB by establishing good TB programmes (DOTS). Patients' adherence to anti-TB drugs and introducing drug sensitivity testing (DST) services at County level hospitals will minimize occurrence of drug resistant.

Characteristics of pulmonary multidrug-resistant tuberculosis patients in Tigray Region, Ethiopia: A cross-sectional study

“…The overall proportion of MDR-TB observed in our study was higher compared to previous studies conducted in Addis Ababa, Ethiopia [ 22 , 23 ], northwest Ethiopia [ 24 , 25 ], Jigjiga in the Somali Region [ 9 ] and the Oromia Region [ 26 ], which showed an overall prevalence of MDR-TB of 11.5%, 5.6%, 10.2%, 1.8%, 1.8% and 4.7%, respectively. The finding was also higher than the study done in China [ 27 ], Kenya [ 28 ], Tanzania [ 29 ], India [ 30 ], Vietnam [ 31 ], Lima Peru [ 32 ], Dalian China [ 33 ] and northeastern China [ 34 ], where the overall MDR-TB prevalence was estimated at 11.3%, 4.8%, 6.3%, 5.6%, 6.9%, 6.6%, 10.1%, 8.7%, respectively. Conversely, the overall MDR-TB proportion observed in our study was lower than former study findings, which showed a 39.4%, 27.2%, 39.2% and 26% overall MDR-TB prevalence reported from Addis Ababa, Ethiopia [ 12 ], southwest Ethiopia [ 10 ], Uganda [ 35 ] and Taiwan [ 36 ], respectively.…”

Epidemiology of first-and second-line anti-tuberculosis drug resistance in new pulmonary tuberculosis cases in Addis Ababa metropolitan area, Ethiopia

“…The rate of MDR-TB identified in this study was 5.8%, (9/156) among new presumptive TB cases and this was congruent to the rate of MDR-TB reported in the previous studies by Tessema B et al, (3.7%, 2012) [28], Yigzaw WB et al, (5.0%, 2021) [40] in Ethiopia; Yonge SA et al, (4.8%, 2017) [46] in Kenya and Dosso M et al, (5.3%, 1999) [32] in Côte d'Ivoire. However, compared to our study findings, a higher rate of MDR-TB was reported in the previous studies by Welekidan LN et al, (11.6%, 2020) [49], and Dagne B et al, (61.9%, 2021) [39] in Ethiopia; Ullah I et al, (9.3%, 2016) [35] in Pakistan; Monde N et al, (9.8%, 2023) [41] in Zambia, Thapa G et al, (15.6%, 2016) [42] in Nepal, Li Y et al, (13.2%, 2016) [43], and Zhou L et al, (18.8%, 2022) [50] in China and Aung WW et al, (18.3%,2015) [51], and Lobie TA et al, (2.3%, 2020) [30] in Ethiopia; Glasauer S et al, (3.3%, 2019) [34] in Germany.…”

“…Ndung'u PW et al, (30.0%, 2012) [44], Kerubo G et al, (30.0%, 2016) [45] and Yonge SA et al, (48.6%, 2017) [46] in Kenya; and Aung WW et al, (27.7%, 2015) [47] in Myanmar. However, a lower rate of resistance of M. tuberculosis strains in new presumptive pulmonary TB cases was reported in the previous studies by Biadglegne F et al, (6.7%, 2014) [48] in Ethiopia.…”

Prevalence and Clinical Profile of Tuberculosis Patients in a Rural Teaching Hospital in South-South Nigeria: A Ten-Year Retrospective Study

“…In this study, the average age of TB patients was 44.7 years, which is similar to the mean age of 41.2 years reported by Bilagi et al [11]. However, some earlier Nigerian studies reported lower mean age ranges [12,13]. The age groups that had the highest incidence of TB in this study were individuals aged 31-40 and 51-60 years old.…”