Primary drug resistance in extra-pulmonary tuberculosis: a hospital-based prospective study from Pakistan

Tahseen, Sabira; Ambreen, Atiqa; Masood, Faisal; Qadir, Mehmood; Hussain, Ashfaq; Jamil, Muhammad; Safdar, Nauman; Sviland, Lisbet; Mustafa, Tehmina

doi:10.5588/ijtld.18.0531

Cited by 15 publications

(14 citation statements)

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“…to our findings, a study reported from India indicated a high proportion (38.2%) of pre-XDR-TB among MDR-TB patients [39]. However, a lower proportion was reported in a similar study conducted in Pakistan [40]. This difference most probably occurred due to treatment failure and MDR-TB burden in the study areas, treatment non-adherence, quality of the drug used, and, TB program-related issues.…”

Section: Plos Onesupporting

confidence: 53%

Molecular characterization and drug resistance patterns of Mycobacterium tuberculosis complex in extrapulmonary tuberculosis patients in Addis Ababa, Ethiopia

et al. 2020

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Background Molecular characterization of Mycobacterium tuberculosis (MTB) is important to understand the pathogenesis, diagnosis, treatment, and prevention of tuberculosis (TB). However, there is limited information on molecular characteristics and drug-resistant patterns of MTB in patients with extra-pulmonary tuberculosis (EPTB) in Ethiopia. Thus, this study aimed to determine the molecular characteristics and drug resistance patterns of MTB in patients with EPTB in Addis Ababa, Ethiopia. Methods This study was conducted on frozen stored isolates of EPTB survey conducted in Addis Ababa, Ethiopia. A drug susceptibility test was performed using BACTEC-MGIT 960. Species and strain identification were performed using the Geno-Type MTBC and spoligotyping technique, respectively. Data were entered into the MIRU-VNTRplus database to assess the spoligotype patterns of MTB. Analysis was performed using SPSS version 23, and participants’ characteristics were presented by numbers and proportions. Results Of 151 MTB isolates, 29 (19.2%) were resistant to at least one drug. The highest proportion of isolates was resistant to Isoniazid (14.6%) and Pyrazinamide (14.6%). Nine percent of isolates had multidrug-resistant TB (MDR-TB), and 21.4% of them had pre-extensively drug-resistant TB (pre-XDR-TB). Among the 151 MTB isolates characterized by spoligotyping, 142 (94.6%) had known patterns, while 9 (6.0%) isolates were not matched with the MIRU-VNTRplus spoligotype database. Of the isolates which had known patterns, 2% was M.bovis while 98% M. tuberculosis. Forty-one different spoligotype patterns were identified. The most frequently identified SpolDB4 (SIT) wereSIT149 (21.2%), SIT53 (14.6%) and SIT26 (9.6%). The predominant genotypes identified were T (53.6%), Central Asia Strain (19.2%) and Haarlem (9.9%). Conclusion The present study showed a high proportion of MDR-TB and pre-XDR-TB among EPTB patients. The strains were mostly grouped into SIT149, SIT53, and SIT26. The T family lineage was the most prevalent genotype. MDR-TB and pre-XDR-TB prevention is required to combat these strains in EPTB. A large scale study is required to describe the molecular characteristics and drug resistance patterns of MTB isolates in EPTB patients.

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Section: Plos Onesupporting

confidence: 53%

Molecular characterization and drug resistance patterns of Mycobacterium tuberculosis complex in extrapulmonary tuberculosis patients in Addis Ababa, Ethiopia

et al. 2020

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“…However prevalence estimates in children can also be argued as not being a true representative of childhood TB population as most likely specimens from sicker children having access to specialized TB care and diagnostic facilities were tested. Among RMP sensitive new EPTB patient (n = 1058), INH resistance of 6.8% (95%CI; 5.4-8.5) was significantly lower compared to PTB (P < .001) in same study population but was consistent with primary drug resistance (5.6%, 95CI; 2.7-10.0) reported in EPTB [19] and PTB in Pakistan [14,20,24]. Most of the EPTB patients in contrast to PTB, were referred for diagnosis of TB and only a few had history of previous TB treatment (<10%), with possibility of these estimates being a true reflection of RsHr in EPTB at population level.…”

Section: Plos Onesupporting

confidence: 74%

“…Annual trend for INH resistance was analyzed for years with DST results available by both methods for more than 100 patients. For FQ resistance, all strains reported resistant to OFX (2015-17), LFX (2018- 19) or showing FQ conferring mutations on LPA were considered LFX resistant. Results were compared with the prevalence estimates of resistance reported in DRS [14] and primary drug resistance in EPTB [19].…”

Section: Discussionmentioning

confidence: 99%

Isoniazid resistance profile and associated levofloxacin and pyrazinamide resistance in rifampicin resistant and sensitive isolates/from pulmonary and extrapulmonary tuberculosis patients in Pakistan: A laboratory based surveillance study 2015-19

Tahseen

Khanzada²,

Rizvi³

et al. 2020

PLoS ONE

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Background Pakistan is among top five high burden countries for tuberculosis and drug resistant TB. Among rifampicin sensitive new pulmonary TB (PTB), prevalence of isoniazid resistance is 8.3% (95%CI: 7.0-10.7) and resistance to fluoroquinolone is higher (11�1%, 95%CI: 7�8-14�3) than isoniazid resistance. Method Five year retrospective data (2015-2019) of drug susceptibility testing (DST) for Mycobacterium tuberculosis isolates, performed using recommended phenotypic (pDST) and/or genotypic (gDST) methods was analyzed stratified by rifampicin results for isoniazid resistance profiles and associated levofloxacin and pyrazinamide resistance.

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“…12 Our findings and their implications in terms of a modified testing algorithm probably apply to many other settings in which the classic Xpert assay continues to be used for early diagnosis and active casefinding strategies, as per WHO recommendations. 28 Moreover, the higher risk of false rifampicin resistance with Xpert testing on samples with a low bacillary load is also important for children 29 and people with extrapulmonary tuberculosis, 30 who generally present with paucibacillary tuberculosis.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and drivers of false-positive rifampicin-resistant Xpert MTB/RIF results: a prospective observational study in Rwanda

et al. 2020

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Background The Xpert MTB/RIF (Xpert) assay is used globally to rapidly diagnose tuberculosis and resistance to rifampicin. We investigated the frequency and predictors of false-positive findings of rifampicin resistance with Xpert.Methods We did a prospective, observational study of individuals who were enrolled in a Rwandan nationwide diagnostic cohort study (DIAMA trial; NCT03303963). We included patients identified to have rifampicin resistance on initial Xpert testing. We did a repeat Xpert assay and used rpoB Sanger and deep sequencing alongside phenotypic drug susceptibility testing (pDST) to ascertain final rifampicin susceptibility status, with any (hetero)resistant result overriding. We used multivariable logistic regression to assess predictors of false rifampicin resistance on initial Xpert testing, adjusted for HIV status, tuberculosis treatment history, initial Xpert semi-quantitative bacillary load, and initial Xpert probe.

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Primary drug resistance in extra-pulmonary tuberculosis: a hospital-based prospective study from Pakistan

Cited by 15 publications

References 0 publications

Molecular characterization and drug resistance patterns of Mycobacterium tuberculosis complex in extrapulmonary tuberculosis patients in Addis Ababa, Ethiopia

Molecular characterization and drug resistance patterns of Mycobacterium tuberculosis complex in extrapulmonary tuberculosis patients in Addis Ababa, Ethiopia

Isoniazid resistance profile and associated levofloxacin and pyrazinamide resistance in rifampicin resistant and sensitive isolates/from pulmonary and extrapulmonary tuberculosis patients in Pakistan: A laboratory based surveillance study 2015-19

Prevalence and drivers of false-positive rifampicin-resistant Xpert MTB/RIF results: a prospective observational study in Rwanda

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