Tuberculosis among household contacts of multidrug-resistant tuberculosis patients in Delhi, India

Singla, Neeta; Singla, Rupak; Jain, Gaurav; Habib, Lura A.; Behera, Digamber

doi:10.5588/ijtld.10.0564

Cited by 32 publications

(23 citation statements)

References 2 publications

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“…41 We found only one resistant case (1.02%) with history of contact with MDR TB. This is consistent with a study done by N Singla et al 42 in which only 0.66% of contacts developed MDR TB. Three patients (3.06%) among rifampicin resistant cases were found to be HIV seropositive.…”

Section: Discussionsupporting

confidence: 93%

A Study to Evaluate Pattern of Rifampicin Resistance in Cases of Sputum Positive Pulmonary Tuberculosis

Ganguly¹,

Ray²,

Nandi³

et al. 2015

jemds

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AIMS:The emergence of drug resistance and development of multidrug resistant tuberculosis (MDR TB) has become a new but significant obstacle for TB control. As Rifampicin resistance is an important indicator for drug resistant TB, rapid diagnosis of tuberculosis and detection of Rifampicin (RIF) resistance are essential for knowing the magnitude of problem & early management of drug resistance TB. The aim of this study is to determine the pattern of rifampicin resistance in the sputum positive MDR TB suspects by using GeneXpert MTB/RIF and thus to focus on magnitude of the problem on drug resistance tuberculosis. STUDY DESIGN: A cross sectional observational study carried out over a period of 2 years in a tertiary care hospital. SUBJECTS & METHODS: In this study 428 sputum positive cases of pulmonary tuberculosis who were potential MDR suspect were included, there sputum samples were collected and tested by GeneXpert MTB/RIF assay, which is an automated cartridge based nucleic acid amplification test to detect presence of mycobacterium tuberculosis and status of Rifampicin resistance. The results are statistically analyzed. RESULTS: Out of 428 patients, mycobacterium tuberculosis was detected in 328 patients (76.63%) & out of these 328 patients, Rifampicin resistance was found in 98 cases (29.87%). Male and female ratio was 6:1 among Rifampicin resistant cases. Regarding age distribution, maximum no. of patients with Rifampicin resistance were in the age group of 21-30 yrs (26.53%) followed by 31-40 yrs (22.44%). In this study among cases of Rifampicin resistance, 23.47% of cases were new smear positive failure patients, retreatment cases smear positive at 4 months were 8.16%, 22.44% of cases were retreatment cases smear positive at diagnosis, 41.83% of cases were retreatment failure cases, 1.03% patient had history of contact with MDR TB and 3.06% patient was HIV seropositive. CONCLUSIONS: Rifampicin resistance cases are found in significant no. of MDR TB suspects. They are mostly male, 21-30 yrs. of age, predominantly retreatment failure cases whereas, new smear positive failure patients also contributes a significant disease burden. Also, HIV seropositive patients should be screened for drug resistance tuberculosis.

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Section: Discussionsupporting

confidence: 93%

A Study to Evaluate Pattern of Rifampicin Resistance in Cases of Sputum Positive Pulmonary Tuberculosis

Ganguly¹,

Ray²,

Nandi³

et al. 2015

jemds

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“…Although adolescents may be able to more easily provide sputum samples for diagnosis when compared with children, they may be less likely to follow up on referrals [32]. A potential strategy for earlier diagnosis is active screening and immediate clinical referral of all household contacts of persons with MDR-TB [33], given that more than one-third of the adolescents in this study had a known MDR-TB contact; had they been identified through an active case-finding strategy, perhaps they would have been diagnosed more quickly and benefitted from earlier treatment.…”

Section: Discussionmentioning

confidence: 99%

Poor Outcomes in a Cohort of HIV-Infected Adolescents Undergoing Treatment for Multidrug-Resistant Tuberculosis in Mumbai, India

Isaakidis¹,

Paryani²,

Khan³

et al. 2013

PLoS ONE

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BackgroundLittle is known about the treatment of multidrug-resistant tuberculosis (MDR-TB) in HIV-co-infected adolescents. This study aimed to present the intermediate outcomes of HIV-infected adolescents aged 10–19 years receiving second-line anti-TB treatment in a Médecins Sans Frontières (MSF) project in Mumbai, India.MethodsA retrospective review of medical records of 11 adolescents enrolled between July 2007 and January 2013 was undertaken. Patients were initiated on either empirical or individualized second-line ambulatory anti-TB treatment under direct observation.ResultsThe median age was 16 (IQR 14–18) years and 54% were female. Five (46%) adolescents had pulmonary TB (PTB), two (18%) extrapulmonary disease (EPTB) and four (36%) had both. Median CD4 count at the time of MDR-TB diagnosis was 162.7 cells/µl (IQR: 84.8–250.5). By January 2013, eight patients had final and 3 had interim outcomes. Favourable results were seen in four (36.5%) patients: one was cured and three were still on treatment with negative culture results. Seven patients (64%) had poor outcomes: four (36.5%) died and three (27%) defaulted. Three of the patients who died never started on antiretroviral and/or TB treatment and one died 16 days after treatment initiation. Two of the defaulted died soon after default. All patients (100%) on-treatment experienced adverse events (AEs): two required permanent discontinuation of the culprit drug and two were hospitalized due to AEs. No patient required permanent discontinuation of the entire second-line TB or antiretroviral regimens.ConclusionsEarly mortality and mortality after default were the most common reasons for poor outcomes in this study. Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from active contact-tracing and immediate referral. Default occurred at different times, suggesting the need for continuous, intensified and individualized psychosocial support for co-infected adolescents. Operational research among co-infected adolescents will be especially important in designing effective interventions for this vulnerable group.

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“…Spread of MDR-TB among household contacts of MDR-TB patients is well documented with a prevalence of MDR-TB in contacts ranging between 1.8% and 11.2% [2]–[11]. Also, MDR-TB outbreaks within health care facilities [12], schools [13], work places [14] and other confined settings [15] have been reported.…”

Section: Introductionmentioning

confidence: 99%

Adverse Events in Healthy Individuals and MDR-TB Contacts Treated with Anti-Tuberculosis Drugs Potentially Effective for Preventing Development of MDR-TB: A Systematic Review

et al. 2013

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A recent systematic review concluded that there is insufficient evidence on the effectiveness to support or reject preventive therapy for treatment of contacts of patients with multidrug resistant tuberculosis (MDR-TB). Whether preventive therapy is favorable depends both on the effectiveness and the adverse events of the drugs used. We performed a systematic review to assess adverse events in healthy individuals and MDR-TB contacts treated with anti-tuberculosis drugs potentially effective for preventing development of MDR-TB. We searched MEDLINE, EMBASE, and other databases (August 2011). Record selection, data extraction, and study quality assessment were done in duplicate. The quality of evidence was assessed using the GRADE approach. Of 6,901 identified references, 20 studies were eligible. Among the 16 studies in healthy volunteers (a total of 87 persons on either levofloxacin, moxifloxacin, ofloxacin, or rifabutin, mostly for 1 week), serious adverse events and treatment discontinuation due to adverse events were rare (<1 and <5%, respectively), but mild adverse events frequently occurred. Due to small sample sizes of the levofloxacin and ofloxacin studies an increased frequency of mild adverse events compared to placebo could not be demonstrated or excluded. For moxifloxacin the comparative results were inconsistent. In four studies describing preventive therapy of MDR-TB contacts, therapy was stopped for 58–100% of the included persons because of the occurrence of adverse events ranging from mild adverse events such as nausea and dizziness to serious events requiring treatment. The quality of the evidence was very low. Although the number of publications and quality of evidence are low, the available evidence suggests that shortly after starting treatment the occurrence of serious adverse events is rare. Mild adverse events occur more frequently and may be of importance because these may provoke treatment interruption.

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Tuberculosis among household contacts of multidrug-resistant tuberculosis patients in Delhi, India

Abstract: The majority of contacts of MDR-TB patients had drug-susceptible TB and the rate of MDRTB was very low. Evaluation of contacts of MDR-TB cases may lead to early diagnosis and prevention of TB.

Cited by 32 publications

References 2 publications

A Study to Evaluate Pattern of Rifampicin Resistance in Cases of Sputum Positive Pulmonary Tuberculosis

A Study to Evaluate Pattern of Rifampicin Resistance in Cases of Sputum Positive Pulmonary Tuberculosis

Poor Outcomes in a Cohort of HIV-Infected Adolescents Undergoing Treatment for Multidrug-Resistant Tuberculosis in Mumbai, India

Adverse Events in Healthy Individuals and MDR-TB Contacts Treated with Anti-Tuberculosis Drugs Potentially Effective for Preventing Development of MDR-TB: A Systematic Review

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