Trends of anti-tuberculosis drug resistance pattern in new cases and previously treated cases of extrapulmonary tuberculosis cases in referral hospitals in northern India

“…In our study, we found 10.6% culture positivity of Mycobacterium tuberculosis from 510 different extra pulmonary samples which is in agreement with the previous reports, where a positivity rate of 10.5% and 9.14% was reported [ 15 , 16 ]. A higher culture positivity of 30.1% was reported by Maurya et al [ 17 ]. This variation in positivity may well be due to geography and the use of liquid media.…”

Section: Discussionmentioning

confidence: 79%

Rapid Screening of MDR-TB in Cases of Extra Pulmonary Tuberculosis Using Geno Type MTBDRplus

et al. 2016

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BackgroundDrug resistance in tuberculosis is a major public health challenge in developing countries. The limited data available on drug resistance in extra pulmonary tuberculosis stimulated us to design our study on anti-tuberculosis drug resistance pattern in cases of extra pulmonary tuberculosis in a tertiary referral hospital of North India. We performed Geno Type MTBDRplus assay in comparison with conventional drug susceptibility testing by proportion method to study the mutation patterns in rpoB, katG and inhA genes.MethodsA total of 510 extra pulmonary samples were included in this study. After the smear microscopy, all the specimens were subjected for culture on Lowenstein Jensen (LJ) media. Phenotypic drug susceptibility testing (DST) was performed on LJ media for all the MTB isolates and compared with the results of Geno Type MTBDRplus assay which was performed with the DNA isolated from the culture by conventional method.ResultsOf 510 specimens cultured, the total culture positivity obtained was 11.8% (60) encompassing 54 (10.6%) Mycobacterium tuberculosis and 6 (1.2%) non-tubercular mycobacteria (NTM). DST results by Geno Type MTBDRplus assay and solid culture methods were compared in 51 MTB isolates excluding the two Rif indeterminate and one invalid test. Geno Type MTBDRplus accurately identified 13 of 14 rifampicin-resistant strains, 14 of 15 isoniazid-resistant strains and 13 of 14 as multi drug resistant tuberculosis (MDR-TB) in comparison with conventional method. Sensitivity and specificity were 92.86% and 97.30% respectively for detection of RIF resistance, 93.33% and 94.44% respectively for detection of INH resistance, 92.86% and 97.30% respectively for detection of MDR-TB, while the overall concordance of Geno Type MTBDRplus assay with conventional DST was 94.11%. The turn-around time for performing Geno Type MTBDRplus assay test was 48 hours.ConclusionThe problem of MDR in extra pulmonary tuberculosis (EPTB) cannot be overlooked and due attention on patients should be given. Routine use of Geno Type MTBDRplus assay for the diagnosis of MDR-EPTB can substantially reduce the time between diagnosis and drug therapy. Culture along with Geno Type MTBDRplus assay could be a solution for rapid and accurate diagnosis of MDR-TB in low bacillary non sputum specimens.

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“…In the present retrospective analysis our finding of high rates of drug resistance in most specimen types received is of concern, with less than half of isolates showing susceptibility to first line drugs. A study conducted by Maurya et al 6 in northern India reported MDR-TB of 13.4 per cent among EPTB patients, with an overall resistance to anti-TB drugs of 40 per cent. The isolates were of diverse nature in the Mumbai population with a preponderance of Beijing genotype as reported, implying an urgent need for better epidemiological surveillance 21 .…”

Section: Discussionmentioning

confidence: 98%

“…There is limited information in the literature regarding prevalence of drug resistance in EPTB especially from high burden settings like India 6 . The reasons for this include the difficulty in obtaining diagnostic specimens and the limited number of laboratories in the country having the facility to perform culture and drug susceptibility testing (DST) for Mycobacterium tuberculosis from extrapulmonary specimens.…”

mentioning

confidence: 99%

Drug resistance among extrapulmonary TB patients: Six years experience from a supranational reference laboratory

Dusthackeer¹,

Sekar²,

Chidambaram³

et al. 2015

Indian J Med Res

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Background & objectives:There is limited information available about the drug resistance patterns in extrapulmonary tuberculosis (EPTB), especially from high burden countries. This may be due to difficulty in obtaining extrapulmonary specimens and limited facilities for drug susceptibility testing. This study was undertaken to review and report the first and second-line anti-TB drug susceptibility patterns in extrapulmonary specimens received at the National Institute for Research in Tuberculosis (NIRT), Chennai, India, between 2005 and 2012.Methods:Extrapulmonary specimens received from referring hospitals were decontaminated and cultured using standard procedures. Drug susceptibility testing (DST) for Mycobacterium tuberculosis was done by absolute concentration or resistance ratio methods for the first and the second line anti-TB drugs.Results:Between 2005 and 2012, of the 1295 extrapulmonary specimens, 189 grew M. tuberculosis, 37 (19%) cases were multidrug resistant (MDR) while one was extensively drug resistant (XDR). Specimen-wise MDR prevalence was found to be: CSF-10 per cent, urine-6 per cent, fluids and aspirates-27 per cent, pus-23 per cent, lymph nodes-19 per cent. Resistance to isoniazid and ethionamide was found to be high (31 and 38%, respectively).Interpretation & conclusions:Drug resistance including MDR-TB was observed in a significant proportion of extrapulmonary specimens referred for DST. Access to culture and DST for extrapulmonary specimens should be expanded. Guidelines for MDR-TB management should have explicit sections on extra-pulmonary tuberculosis and training on laboratory techniques is urgently required.

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Trends of anti-tuberculosis drug resistance pattern in new cases and previously treated cases of extrapulmonary tuberculosis cases in referral hospitals in northern India

Cited by 38 publications

References 18 publications

Drug-resistant Spinal Tuberculosis

Drug-resistant Spinal Tuberculosis

Rapid Screening of MDR-TB in Cases of Extra Pulmonary Tuberculosis Using Geno Type MTBDRplus

Drug resistance among extrapulmonary TB patients: Six years experience from a supranational reference laboratory

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