Pre-Extensively Drug Resistant Tuberculosis (Pre-XDR-TB) among Pulmonary Multidrug Resistant Tuberculosis (MDR-TB) Patients in Bangladesh

Abstract

Background & Objectives: Emergence of drug resistant Tuberculosis (TB) is a major obstacle in the TB control programme of Bangladesh. This study was carried out to detect pre-extensively drug resistant TB (pre-XDR-TB) cases among the multidrug resistant TB (MDR-TB) patients in Bangladesh, as the early detection of pre-XDR-TB can guide clinicians in the appropriate modification of MDR-TB treatment regimen with effective drugs to prevent treatment failure. Methodology: A total of 68 MDR-TB cases were enrolled in this study. Multiplex Real-time PCR was done to detect pre-XDR-TB cases directly from sputum samples of MDR-TB patients. Results: Out of 68 MDR-TB cases 11 (16.18%) cases were detected as pre-XDR-TB. The resistant profile of the 11 pre-XDR-TB revealed 9 (81.82%) cases of fluoroquinolone (FLQ) resistant pre-XDR-TB and 2 (18.18%) cases of injectable second line (ISL) agent resistant pre-XDR-TB. Out of 11 pre-XDR-TB cases 7 (63.64%) cases had history of taking treatment for MDR-TB regularly, 1 (9.09%) case had history of taking treatment for MDR-TB irregularly and 3 (27.27%) cases had no history of taking treatment for MDR-TB. Conclusion: This study encountered a high rate of pre-XDR-TB cases along with a significant number of primarily resistant bacilli which is of concern in the management of MDR-TB. It is evident that Bangladesh is in urgent need to device strategies for rapid and early detection of pre-XDR-TB in order to prevent treatment failure of MDR-TB cases and also to halt the progression of MDR-TB cases to extensively drug resistant TB (XDR-TB), which is not only difficult but also very expensive to treat.

The burden of pre-extensively and extensively drug-resistant tuberculosis among MDR-TB patients in the Amhara region, Ethiopia

“…The rate of pre-XDR and XDR-TB in our study were 5.7% and 0.6%, respectively. Compared to our findings, majority of studies reported higher rate of pre-XDR TB in India (56%), China (34%), Pakistan (24%), Bangladesh (16%), Nigeria (17%) and South Africa (17%) [21][22][23][24][25]. The high rate of pre-XDRTB in China, India and other countries compared to our study might be connected to the fact that China and India have the highest rate of MDR-TB in the world and a better laboratory setup and resources for the isolation of drug resistant strains.…”

Early detection of Pre-XDR TB with line probe assay in a high TB burden country

“…The resistance observed with the drugs could be attributed to the direct alteration of rrs, the shared target via the A1401G mutation is known to confer unequivocal cross-resistance to all three drugs 7 . The prevalence of 20.5% as revealed in this study is similar to studies done in Nigeria, Bangladesh, South Africa and China where the detection of pre-XDR-TB among MDR-TB patients was 21%, 16.2%, 14.0% and 34% respectively [8][9][10][11] . It is also consistent with prevalence of 16.7% reported among MDR TB patients in South Western zone of Nigeria 12 .…”

Frequency of Pre-Extensively Drug Resistant Tuberculosis and Extensively Drug Resistant Tuberculosis

“…Compared to our findings, majority of studies reported higher rate of pre-XDR TB in India (56%), China (34%), Pakistan (24%), Bangladesh (16%), Nigeria (17%) and South Africa (17%). [10][11][12][13][14] The resistance of FQ in our study was 34.44% and it was similar to other several studies, reported as 10%, 13%, 24%, 35% and 57%. [15][16][17][18][19] Data from previous studies suggests that the incidence of FLQ resistant MDR-TB (pre-XDR-TB) is increasing worldwide.…”