Multi Drug and Other Forms of Drug Resistant Tuberculosis Are Uncommon among Treatment Naïve Tuberculosis Patients in Tanzania

Nagu, Tumaini; Aboud, Said; Mwiru, Ramadhani S.; Matee, Mecky; Fawzi, Wafaie W.; Mugusi, Ferdinand

doi:10.1371/journal.pone.0118601

Cited by 13 publications

(9 citation statements)

References 15 publications

(35 reference statements)

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“…These cases received treatment for multi-drug resistance tuberculosis (MDR-TB) as per existing guideline in Tanzania and elsewhere [ 28 , 29 ]. This low proportion of RR-TB best align with findings by Nagu et al who found uncommon cases of MDR-TB among patients without prior exposure to anti-TB drugs in Tanzania [ 30 ]. Despite these strengths, our study has some limitations.…”

Section: Discussionsupporting

confidence: 88%

Improved performance of Xpert MTB/RIF assay on sputum sediment samples obtained from presumptive pulmonary tuberculosis cases at Kibong’oto infectious diseases hospital in Tanzania

Mbelele

Aboud

Mpagama³

et al. 2017

BMC Infect Dis

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BackgroundThe introduction of Xpert MTB/RIF assay (Xpert) has significantly improved diagnosis of Tuberculosis (TB) in resource limited human immunodeficiency virus (HIV) endemic settings. We aimed to modify the Xpert protocol to improve the detection of Mycobacterium tuberculosis (MTB).MethodsThis cross sectional study was conducted among presumptive pulmonary tuberculosis (PTB) patients at Kibong’oto Infectious Diseases Hospital between August and November 2015. Each patient consented to provide 2 samples of raw sputa. One-sputum sample was sedimented using the Petroff’s method and divided into two portions. One portion of sediment was inoculated on Lowenstein-Jensen culture media and observed for any growth for up to 8 weeks. Both, raw sputum and the portions of sediments were tested separately using Xpert with a sample reagent ratio of 1:2. Mean age of patients, prevalence of MTB, Xpert sensitivity, specificity, positive and negative predictive value were calculated. An incremental sensitivity was determined. Pearson chi-square and either an independent T or Mann-Whitney U-test were used to compared categorical and continuous variables respectively. A p- value of ≤0.05 was considered significant.ResultsOf the 270 presumptive PTB cases, 262 were eligible for analysis. Eight (3%) were excluded due to contaminated culture. Patients’ mean age was 42.9 (±SD 15.1) years of which 173 (66%) were female. The overall prevalence of PTB was 112 (43%), of which the Xpert detected 105 (40%) in sediments and 98 (37%) in raw sputa as compared to culture which detected 85 (32%) cases of PTB. Sensitivity, specificity, positive and negative predictive values of Xpert on sputum sediments were 92%, 85%, 74% and 96% respectively. Overall, the incremental sensitivity of Xpert on sediment over raw sputum was 6%. In HIV infected Presumptive PTB, the incremental sensitivity was 12%.ConclusionLowering the sample reagent to sediment dilution ratio increases sensitivity of Xpert on MTB detection among presumptive PTB cases, especially in HIV infected individuals.

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Section: Discussionsupporting

confidence: 88%

Improved performance of Xpert MTB/RIF assay on sputum sediment samples obtained from presumptive pulmonary tuberculosis cases at Kibong’oto infectious diseases hospital in Tanzania

Mbelele

Aboud

Mpagama³

et al. 2017

BMC Infect Dis

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“…Like in most sub-Saharan African countries, the HIV epidemic contributes substantially to the high TB incidence in Tanzania, where a-third of the TB patients are co-infected with HIV [2]. Contrarily, drug-resistant TB is still low in this setting [3]. Other risk factors such as poverty also influence the epidemiology of TB in Tanzania [4].…”

Section: Introductionmentioning

confidence: 99%

Insights into the genetic diversity of Mycobacterium tuberculosis in Tanzania

et al. 2019

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Background Human tuberculosis (TB) is caused by seven phylogenetic lineages of the Mycobacterium tuberculosis complex (MTBC), Lineage 1–7. Recent advances in rapid genotyping of MTBC based on single nucleotide polymorphisms (SNP), allow for phylogenetically robust strain classification, paving the way for defining genotype-phenotype relationships in clinical settings. Such studies have revealed that, in addition to host and environmental factors, strain variation in the MTBC influences the outcome of TB infection and disease. In Tanzania, such molecular epidemiological studies of TB however are scarce in spite of a high TB burden. Methods and findings Here we used SNP-typing to characterize a nationwide collection of 2,039 MTBC clinical isolates representative of 1.6% of all new and retreatment TB cases notified in Tanzania during 2012 and 2013. Four lineages, namely Lineage 1–4 were identified within the study population. The distribution and frequency of these lineages varied across regions but overall, Lineage 4 was the most frequent (n = 866, 42.5%), followed by Lineage 3 (n = 681, 33.4%) and 1 (n = 336, 16.5%), with Lineage 2 being the least frequent (n = 92, 4.5%). We found Lineage 2 to be independently associated with female sex (adjusted odds ratio [aOR] 2.14; 95% confidence interval [95% CI] 1.31 – 3.50, p = 0.002) and retreatment cases (aOR 1.67; 95% CI 0.95 – 2.84, p = 0. 065) in the study population. We found no associations between MTBC lineage and patient age or HIV status. Our sublineage typing based on spacer oligotyping on a subset of Lineage 1, 3 and 4 strains revealed the presence of mainly EAI, CAS and LAM families. Finally, we detected low levels of multidrug resistant isolates among a subset of 144 retreatment cases. Conclusions This study provides novel insights into the MTBC lineages and the possible influence of pathogen–related factors on the TB epidemic in Tanzania.

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“…Walaupun dalam beberapa kasus ditemukan resistensi primer namun prevalensi tertinggi penyebaran MDR-TB masih menunjukkan jika penderita yang pernah melakukan pengobatan sebelumnya beresiko tinggi terjadinya MDR-TB. Penderita dengan riwayat pengobatan sebelumnya memiliki kemungkinan resisten 4 kali lebih besar terjadinya resisten dan untuk MDR-TB memiliki 10 kali lebih besar dari pada penderita yang belum pernah mendapatkan pengobatan (Nagu et al, 2015). Panjangnya pengobatan TB menjadikan penderita jenuh untuk menjalankan pengobatannya, kemudian disanalah peran penting pendamping minum obat untuk mengawasi sekaligus mengingatkan dalam pengobatan.…”

Section: Latar Belakangunclassified

Evaluation of Multi-Drug Resistant Tuberculosis Predictor Index in Surakarta, Central Java

Pamungkas

Rahardjo

Murti

2018

J EPIDEMIOL PUBLIC HEALTH

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Background: Tuberculosis (TB) remains a global public health problem. New cases of lung Tuberculosis in 2015 were 10.4 million worldwide. One of the challenging in TB control to be addressed is the development of Multi Drug Resistant Tuberculosis (MDR-TB). There were an estimated 15,380 TB cases in Indonesia by 2015 with 1,860 positive TB cases and 1,566 cases successfully treated. This study aimed to determine the predictor index for MDR-TB. Subjects and Method:This was an analytic observational study with a case-control design. The study was conducted at Dr. Moewardi Hospital, Surakarta, Central Java, from August to November 2017. The study subjects were selected by fixed disease sampling including 75 MDR-TB patients and 75 TB patients. The dependent variable was MDR-TB. The independent variables were medical history, co-morbidity (Diabetes Mellitus), drug side effect, drug-taking supervisor, and regularity of treatment. The data were collected by questionnaire and medical record. The data were analyzed by a multiple logistic regression. Results: MDR-TB Occurrence Index increased with drug-taking supervisor (b = 2.33; 95% CI= 3.83 to 27.91; p<0.001), drug-side effect (b = 0.73; 95% CI= 0.58 to 7.45; p=0.026), medical history (b = 2.35; 95% CI= 3.80 to 29.38; p<0.001). MDR-TB Occurrence Index decreased by absence of type 2 Diabetes Mellitus (b = -0.56; 95% CI= 0.18 to 1.78; p= 0.033), regular treatment (b = -1.73; 95% CI= 0.06 to 0.46; p<0.001). Conclusion: MDR-TB Occurrence Index is determined by drug-taking supervisor, drug-side effect, medical history, Type 2 Diabetes Mellitus, and regular treatment.

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Multi Drug and Other Forms of Drug Resistant Tuberculosis Are Uncommon among Treatment Naïve Tuberculosis Patients in Tanzania

Cited by 13 publications

References 15 publications

Improved performance of Xpert MTB/RIF assay on sputum sediment samples obtained from presumptive pulmonary tuberculosis cases at Kibong’oto infectious diseases hospital in Tanzania

Improved performance of Xpert MTB/RIF assay on sputum sediment samples obtained from presumptive pulmonary tuberculosis cases at Kibong’oto infectious diseases hospital in Tanzania

Insights into the genetic diversity of Mycobacterium tuberculosis in Tanzania

Evaluation of Multi-Drug Resistant Tuberculosis Predictor Index in Surakarta, Central Java

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