Multidrug Resistance Tuberculosis (MDR-TB) And Pre-Extensively Resistant Tuberculosis (Pre-XDR TB) In A 27 Year Old TB/HIV Co-Infected Patient In Ibadan, Oyo State, Nigeria A Case Report

Daniel, Olusoji; Osman, E.A.; Dairo, OG; Lawal, Wole

doi:10.4314/njcm.v5i1.7

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“…The difference may be due to a smaller sample size and selection criteria considered in our study. Other studies have reported the prevalence rate of pre-XDR among MDR-TB strains to be 27% and 16.7% in Zimbabwe [23] and Nigeria [24], respectively. The lower prevalence of pre-XDR in Zambia when compared to other countries could be that drug susceptibility testing and initiation of patients on second-line TB drugs, are only performed in very few designated health facilities in the country due to inadequate diagnostic capacity in other facilities.…”

Section: Discussionmentioning

confidence: 93%

Genomic Analysis of Mycobacterium tuberculosis Strains Resistant to Second-Line Anti-Tuberculosis Drugs in Lusaka, Zambia

et al. 2023

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The emergence of pre-extensively drug-resistant tuberculosis (pre-XDR-TB) is a threat to TB control programs in developing countries such as Zambia. Studies in Zambia have applied molecular techniques to understand drug-resistance-associated mutations, circulating lineages and transmission patterns of multi-drug-resistant (MDR) Mycobacterium tuberculosis. However, none has reported genotypes and mutations associated with pre-XDR TB. This study characterized 63 drug-resistant M. tuberculosis strains from the University Teaching Hospital between 2018 and 2019 using targeted gene sequencing and conveniently selected 50 strains for whole genome sequencing. Sixty strains had resistance mutations associated to MDR, one polyresistant, and two rifampicin resistant. Among MDR strains, seven percent (4/60) had mutations associated with pre-XDR-TB. While four, one and nine strains had mutations associated with ethionamide, para-amino-salicylic acid and streptomycin resistances, respectively. All 50 strains belonged to lineage 4 with the predominant sub-lineage 4.3.4.2.1 (38%). Three of four pre-XDR strains belonged to sub-lineage 4.3.4.2.1. Sub-lineage 4.3.4.2.1 strains were less clustered when compared to sub-lineages L4.9.1 and L4.3.4.1 based on single nucleotide polymorphism differences. The finding that resistances to second-line drugs have emerged among MDR-TB is a threat to TB control. Hence, the study recommends a strengthened routine drug susceptibility testing for second-line TB drugs to stop the progression of pre-XDR to XDR-TB and improve patient treatment outcomes.

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Section: Discussionmentioning

confidence: 93%