Multidrug-Resistant Tuberculosis (Mdr-Tb): An Emerging Problem in West Africa

Otu, Jacob; Gehre, Florian; Zingué, Dezemon; Kudzawu, Samuel; Forson, Audrey; Mané, Morto; Rabna, Paulo; Diarra, Bassirou; Kayede, Salako; Adebiyi, Emmanuel; Kehinde, Aderemi; Onyejepu, Nneka; Onubogu, Catherine; Idigbe, Emmanuel O.; Ba, Awa; Diallo, Astou Coly Niassy; Mboup, Souleymane; Disse, K.; Kadanga, Gérard; Dagnra, Yaotsè Anoumou; Baldeh, Ignatius; Corrah, Tumani; Jong, Bouke De; Antonio, Martín

doi:10.1136/bmjgh-2016-000260.85

Cited by 3 publications

(5 citation statements)

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“…Although the WHO estimated 20.5% MDR-TB for retreatment cases (classified as patients who have been previously treated for TB and have reported again with the disease), the network reported 35% for the eight West African countries (28,180). In another study that screened isolates from the eight West African countries from 2012 to 2014, the authors also reported the same 6% MDR-TB for new cases and 34% for retreatment cases (30). This shows the prevalence of drug resistance in West Africa has been fairly constant and multidrug resistance has become an emerging health challenge in West Africa.…”

Section: Mechanism Of Drug Resistance Emergence and Evolutionmentioning

confidence: 82%

“…Drug sensitive active TB cases are treated with a 6-month multi-drug therapy which includes INH, RIF, pyrazinamide (PZA), and ethambutol (EMB) (26) which has ∼85% treatment success (4). However, there are recent reports of the emergence and high burden of drug resistant TB in the regions (27)(28)(29)(30). Drug-resistant TB remains a public health threat.…”

Section: Control Of Tuberculosis and Its Challengesmentioning

confidence: 99%

“…West Africa is unique in its MTBC genotypes and evolution of drug resistance which calls for further molecular investigation. Although a number of the resistant isolates reported in the sub-region were sequenced and analyzed for the presence of mutations associated with drug resistance, there is still a lot that were only characterized by phenotypic methods (18,28,30,144).…”

Section: Mechanism Of Drug Resistance Emergence and Evolutionmentioning

confidence: 99%

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The Relevance of Genomic Epidemiology for Control of Tuberculosis in West Africa

Asare

Asante-Poku

Osei-Wusu

et al. 2021

Front. Public Health

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Tuberculosis (TB), an airborne infectious disease caused by Mycobacterium tuberculosis complex (MTBC), remains a global health problem. West Africa has a unique epidemiology of TB that is characterized by medium- to high-prevalence. Moreover, the geographical restriction of M. africanum to the sub-region makes West Africa have an extra burden to deal with a two-in-one pathogen. The region is also burdened with low case detection, late reporting, poor treatment adherence leading to development of drug resistance and relapse. Sporadic studies conducted within the subregion report higher burden of drug resistant TB (DRTB) than previously thought. The need for more sensitive and robust tools for routine surveillance as well as to understand the mechanisms of DRTB and transmission dynamics for the design of effective control tools, cannot be overemphasized. The advancement in molecular biology tools including traditional fingerprinting and next generation sequencing (NGS) technologies offer reliable tools for genomic epidemiology. Genomic epidemiology provides in-depth insight of the nature of pathogens, circulating strains and their spread as well as prompt detection of the emergence of new strains. It also offers the opportunity to monitor treatment and evaluate interventions. Furthermore, genomic epidemiology can be used to understand potential emergence and spread of drug resistant strains and resistance mechanisms allowing the design of simple but rapid tools. In this review, we will describe the local epidemiology of MTBC, highlight past and current investigations toward understanding their biology and spread as well as discuss the relevance of genomic epidemiology studies to TB control in West Africa.

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Section: Mechanism Of Drug Resistance Emergence and Evolutionmentioning

confidence: 82%

Section: Control Of Tuberculosis and Its Challengesmentioning

confidence: 99%

Section: Mechanism Of Drug Resistance Emergence and Evolutionmentioning

confidence: 99%

See 1 more Smart Citation

The Relevance of Genomic Epidemiology for Control of Tuberculosis in West Africa

Asare

Asante-Poku

Osei-Wusu

et al. 2021

Front. Public Health

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“…There is a lack of data on the incidence of drug-resistant TB in many countries, particularly in sub-Saharan Africa. 4 Multi-drug resistant TB emerges primarily from poor management of those affected by the disease, which requires appropriate diagnosis and timely treatment in order for effective containment. Thus, efforts must be focused on the correct medications in each new case.…”

Section: Introductionmentioning

confidence: 99%

Phenotypic Drug Resistance Pattern and Mutation Characteristics of Mycobacterium tuberculosis from Different Body Fluids Among Extra Pulmonary Patients Presented in Selected Hospitals in Addis Ababa, Ethiopia

Alehegn,

Gebreyohanns,

Berhane

et al. 2023

IDR

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Background: Drug resistance in tuberculosis poses challenges to both the control and prevention of the disease. The extent of resistance is not well known in developing countries, including Ethiopia. This study was conducted to determine the drug resistance patterns and mutation characteristics of Mycobacterium tuberculosis among extra pulmonary tuberculosis patients in selected health facilities in Addis Ababa. Material and Methods: A cross-sectional study was conducted from February 2022 to August 2022 in selected hospitals in Addis Ababa. Socio-demographic and clinical data were collected using structured questionnaire. Mycobacterium tuberculosis complex (MTBC) isolates were tested for phenotypic drug susceptibility patterns using the Mycobacterium growth indicator tube (MGIT) method for first-line drugs and mutation characteristics using the Line Probe Assay (LPA) method. The data were analyzed using: SPSS version 23, and a P-value ≤ 0.05 was considered statistically significant. Results: From a total of 308 patient samples from presumptive extra pulmonary patients, 44 (14.3%) were positive for MTBC. Any drug resistance was discovered in 25% of 44 MTBC isolates evaluated for five first-line drugs phenotypically, with isoniazid (INH) and pyrazinamide (PZA) resistance accounting for a greater proportion with 13.6% and 11.4% of the isolates, respectively. Two (4.5%) of the isolates were MDR-TB. Out of 44 isolates tested using the Geno Type MTBDRplus assay, 5 (11.4%) showed mutations at katG and 2 (4.5%) showed mutations in the rpoB genes. Conclusion: Both the phenotypic and genotypic drug susceptibility test results showed a high proportion of INH resistance. All INH resistance-conferring mutations were identified from katG gene. The overall prevalence of MDR-TB was also high. For early case detection and treatment, expanding diagnostic capacity for first-line DST is a vital step to limit further spread of drug resistant TB strains in the study area.

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“…Drug resistant tuberculosis (DR-TB) is a threat to tuberculosis (TB) control with ~ 500,000 cases of rifampicin resistance (RR) reported in 2019 [ 1 ]. In some parts of sub-Saharan Africa (SSA), the prevalence of DR-TB has been reported to be 20% among new TB patients, 53% among previously treated TB patients and the rate of decline of multi-drug resistant TB (MDR-TB) in SSA is dismal [ 2 , 3 ]. The MDR-TB treatment success rate is low and only 57% of patients on conventional treatment regimens have a successful outcome [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary management of difficult-to-treat drug resistant tuberculosis: a review of cases presented to the national consilium in Uganda

et al. 2021

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Background Patients with drug resistant tuberculosis (DR-TB) with comorbidities and drug toxicities are difficult to treat. Guidelines recommend such patients to be managed in consultation with a multidisciplinary team of experts (the “TB consilium”) to optimise treatment regimens. We describe characteristics and treatment outcomes of DR-TB cases presented to the national DR-TB consilium in Uganda between 2013 and 2019. Methods We performed a secondary analysis of data from a nation-wide retrospective cohort of DR-TB patients with poor prognostic indicators in Uganda. Patients had a treatment outcome documented between 2013 and 2019. Characteristics and treatment outcomes were compared between cases reviewed by the consilium with those that were not reviewed. Results Of 1,122 DR-TB cases, 189 (16.8%) cases from 16 treatment sites were reviewed by the consilium, of whom 86 (45.5%) were reviewed more than once. The most frequent inquiries (N = 308) from DR-TB treatment sites were construction of a treatment regimen (38.6%) and management of side effects (24.0%) while the most frequent consilium recommendations (N = 408) were a DR-TB regimen (21.7%) and “observation while on current regimen” (16.6%). Among the cases reviewed, 152 (80.4%) were from facilities other than the national referral hospital, 113 (61.1%) were aged ≥ 35 years, 72 (40.9%) were unemployed, and 26 (31.0%) had defaulted antiretroviral therapy. Additionally, 141 (90.4%) had hepatic injury, 55 (91.7%) had bilateral hearing loss, 20 (4.8%) had psychiatric symptoms and 14 (17.7%) had abnormal baseline systolic blood pressure. Resistance to second-line drugs (SLDs) was observed among 9 (4.8%) cases while 13 (6.9%) cases had previous exposure to SLDs. Bedaquiline (13.2%, n = 25), clofazimine (28.6%, n = 54), high-dose isoniazid (22.8%, n = 43) and linezolid (6.7%, n = 13) were more frequently prescribed among cases reviewed by the consilium than those not reviewed. Treatment success was observed among 126 (66.7%) cases reviewed. Conclusion Cases reviewed by the consilium had several comorbidities, drug toxicities and a low treatment success rate. Consilia are important “gatekeepers” for new and repurposed drugs. There is need to build capacity of lower health facilities to construct DR-TB regimens and manage adverse effects.

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Multidrug-Resistant Tuberculosis (Mdr-Tb): An Emerging Problem in West Africa

Abstract: Background Multidrug-resistant tuberculosis (MDR-TB) remains a clear threat to TB control. There is a paucity of data A32

Cited by 3 publications

References 0 publications

The Relevance of Genomic Epidemiology for Control of Tuberculosis in West Africa

The Relevance of Genomic Epidemiology for Control of Tuberculosis in West Africa

Phenotypic Drug Resistance Pattern and Mutation Characteristics of Mycobacterium tuberculosis from Different Body Fluids Among Extra Pulmonary Patients Presented in Selected Hospitals in Addis Ababa, Ethiopia

Multidisciplinary management of difficult-to-treat drug resistant tuberculosis: a review of cases presented to the national consilium in Uganda

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