Multidrug resistant tuberculosis: A challenge in clinical orthopedics

Tuli, Surendra Mohan

doi:10.4103/0019-5413.132487

Cited by 9 publications

(4 citation statements)

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“…As a result, Prof. Tuli had defined certain clinical criteria to suspect drug resistance in spinal TB. [ 17 ] According to these, in a patient with spinal TB who has been on ATT for at least 5 months, resistance should be suspected in the presence of poor clinical and radiological response, the appearance of a new tubercular lesion, worsening of spinal deformity, formation of a discharging sinus, and dehiscence of the previous scar of surgery for spinal TB.…”

Section: W Hat a Bout M mentioning

confidence: 99%

Spinal tuberculosis treatment: An enduring bone of contention

Garg

Goyal

2020

Ann Indian Acad Neurol

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Section: W Hat a Bout M mentioning

confidence: 99%

Spinal tuberculosis treatment: An enduring bone of contention

Garg

Goyal

2020

Ann Indian Acad Neurol

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“…The rapid detection of drug-resistant TB improves treatment outcomes and prevents disease transmission [ 3 ]. Among OATB cases, suspected (presumptive) drug-resistant TB can be identified as patients showing failure of clinico-radiological improvement, deterioration of existing lesions, or the appearance of a fresh lesion/abscess while on anti-tubercular therapy (ATT) for a minimum of four to five months [ 4 ]. The drug sensitivity testing (DST) methods include culture-based (phenotypic) and nucleic acid-based (genotypic) methods such as GeneXpert® MTB/RIF ( Mycobacterium tuberculosis/rifampicin ) assay (Cepheid, Sunnyvale, California,, United States), cartridge-based nucleic acid amplification test (CBNAAT), and line probe assay (LPA) for first and second-line drugs.…”

Section: Introductionmentioning

confidence: 99%

Drug Resistance in Osteoarticular Tuberculosis: A Study From an Endemic Zone

Gain,

Jain,

Bhalla

et al. 2023

Cureus

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Background: The present study was undertaken to determine the incidence of drug resistance against anti-tubercular drugs among patients from an endemic zone. Methodology: Forty consecutive clinico-radiologically diagnosed patients of osteoarticular tuberculosis (29: spine, 11: extraspinal) were enrolled. Pus from needle aspiration was taken in 31 cases, tissue following spinal decompression in seven, synovial in one, and sinus edge biopsy in one. The pus/tissue was subjected to acid-fast bacilli (AFB) staining and liquid culture, sensitivity to 13 anti-tubercular drugs (Isoniazid (INH), rifampicin (RIF), kanamycin (KAN), amikacin (AMK,) capreomycin (CAP), ethionamide (ETH), levofloxacin (LEV), moxifloxacin (MOX), linezolid (LNZ), para-amino-salicylic acid (PAS), bedaquiline (BDQ), delamanid (DLM), and clofazimine (CFO)) were checked, and histopathological/cytopathological examination and molecular tests were performed. Results: The mean age of patients was 29.07(9-65) years; 21 were female and 19 were male. The diagnostic accuracy for tuberculosis was 20% by AFB smear, 65% by liquid culture, 82.5% by histopathology, and 90% by cartridge-based nucleic acid amplification testing (CBNAAT). All culture-positive isolates were identified as Mycobacterium tuberculosis with no non-tubercular Mycobacterium . The drug resistance detected on CBNAAT was 11.1%, line probe assay (LPA) first line was 15.4%, LPA second line was 4%, and liquid drug susceptibility testing (DST) 11.5%. We detected 15.4% INH resistance, 11.1% RIF, 7.6% LEV, 3.8% MOX and PAS. No resistance was detected against second-line injectable drugs (SLID), ETH, LNZ, BDQ, DLM, and CFO. Conclusions: No single laboratory modality can ascertain the diagnosis in all cases; hence, samples should be sent for all tests in tandem. In the presence of insufficient samples, tissue may be subjected to CBNAAT and histopathology to arrive at tissue diagnosis. In this subset, overall drug resistance incidence was 12.5% (5/40) with one patient each of isolated INH and RIF resistance, one of multidrug-resistance (MDR), and two of pre-extensively drug-resistant (pre-XDR). Primary drug resistance came out to be 11.1% (4/36) with one patient each of isolated INH and RIF resistance, one of MDR, and one Pre-XDR.

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“…Diabetes is one of the risk factors of tuberculosis due to its immune-compromising effect. It is known to affect the natural course of TB by making individuals have a lifetime risk of getting TB infection activated from the latent stage of infection, getting more severe symptoms, treatment failure, more lapses as well as more prone to death [52,30]. There is also a likelihood for misdiagnosis of patients with TB who have diabetes because these patients show typical imaging changes and lesion distribution in the lower lobe instead of the upper lobe, which TB infected patient shows [22].…”

Section: Introductionmentioning

confidence: 99%