ASSESSMENT OF EFFECTIVENESS OF THE EMPIRIC TREATMENT REGIMEN IN TUBERCULOSIS PATIENTS SUSPECTED WITH MULTIPLE DRUG RESISTANCE IN THE RUSSIAN FEDERATION
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Abstract:
ОЦЕНКА РЕЗУЛЬТАТИВНОСТИ ПРИМЕНЕНИЯ В РОССИЙСКОЙ ФЕДЕРАЦИИ ЭМПИРИЧЕСКОГО РЕЖИМА ЛЕЧЕНИЯ БОЛЬНЫХ ТУБЕРКУЛЕЗОМ С ПРЕДПОЛАГАЕМОЙ МНОЖЕСТВЕННОЙ ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТЬЮС. А. СТЕРЛИКОВ 1 , АKeywords:
Regimen
Drug resistant tuberculosis
Aim. To study the current state of the epidemic status of co-infection of human immunodeficiency virus (HIV) and tuberculosis in penitentiary facilities and to predict its further development.
Methods. The material for the study was the data of departmental forms of medical statistical reporting for the period from 2005 to 2018.
Results. It has been established that the epidemic status of tuberculosis in the penitentiary system institutions is improving, reflected by a decrease in mortality rate over the study period by more than 90%. However, over the study period, the incidence of co-infection of HIV and tuberculosis in penitentiary institutions increased by 3.9 times, and the prevalence by more than 2.5 times. This trend is largely due to the growth of epidemiological indicators of HIV infection. This confirms the established fact that the proportion of HIV-infected people among people followed up with active tuberculosis increased by almost 10 times. Currently, more than one in three newly diagnosed patients with active tuberculosis is infected with HIV. Along with this, the proportion of cases with drug resistance is growing among bacillary patients with active tuberculosis.
Conclusion. The increase in the number of people with co-infection with HIV and tuberculosis and drug-resistant forms of tuberculosis raises doubts on further favorable prognosis for the development of the epidemic situation on tuberculosis both in penitentiary institutions and in the Russian Federation as a whole: an epidemic potential is emerging for an even more complex problem HIV-associated tuberculosis with drug resistance.
Drug resistant tuberculosis
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Drug resistant tuberculosis
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Background Zambia like many countries in sub-Saharan Africa is affected with drug resistant tuberculosis. However, the drug resistant tuberculosis situation over the years has not been described in various regions of the country. Consequently, this study aims to determine the drug resistant tuberculosis burden in northern regions of Zambia over a four-year period based on data generated from a Regional Tuberculosis Reference Laboratory. Method Two hundred and thirty two (232) Tuberculosis Drug Susceptibility Testing results over a four-year period (2016-2019) were reviewed. Data was collected from tuberculosis registers and patient request forms and entered into a pre-tested standardized checklist and later entered in Excel Computer software. Double blinded checking was done by two independent data clerks to minimize duplication of cases. Cleaned data was then imported in R programme for analysis. Bivariant and descriptive statistics were performed and reported. Results Of 232 Drug Susceptibility Testing results, 90.9% were drug resistant TB while 9% were drug susceptible. Fifty three percent (53%) of these were multi-drug resistant Tuberculosis and 32% were confirmed as Rifampicin Mono-resistance. Only 1.7% of the Multi-drug resistant Tuberculosis patients were Pre-extensively drug-resistant Tuberculosis. Copperbelt province had the largest proportion (46.0%) of multi-drug resistant tuberculosis patients followed by Luapula (8.1%) and North-Western (4.7%) provinces. In new and previously treated patients, the proportion of Multi-drug resistant tuberculosis was 71.8% and 28.7% respectively. History of previous anti-tuberculosis treatment and treatment failure were associated with multi-drug resistance TB. Conclusion and Recommendation This study has shown a small increase in the proportions of drug resistant tuberculosis cases over the four years under review with high rates being recorded on the Copperbelt Province. Previous treatment to first line TB treatment and treatment failure were associated with development of Multi-drug resistance. We therefore recommend strengthened routine laboratory surveillance and improved case management of multi-drug resistant tuberculosis patients in the region.
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ABSTRACT The long-term persistence of Mycobacterium tuberculosis in communities with high tuberculosis prevalence is a serious problem aggravated by the presence of drug-resistant tuberculosis strains. Drug resistance in an individual patient is often discovered only after a long delay, particularly if the diagnosis is based on current culture-based drug sensitivity testing methods. During such delays, the patient may transmit tuberculosis to his or her contacts. Rapid diagnosis of drug resistance would be expected to reduce this transmission and hence to decrease the prevalence of drug-resistant strains. To investigate this quantitatively, a mathematical model was constructed, assuming a homogeneous population structure typical of communities in South Africa where tuberculosis incidence is high. Computer simulations performed with this model showed that current control strategies will not halt the spread of multidrug-resistant tuberculosis in such communities. The simulations showed that the rapid diagnosis of drug resistance can be expected to reduce the incidence of drug-resistant cases provided the additional measure of screening within the community is implemented.
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Among new tuberculosis cases in Uganda, 10.3% are drug-resistant and 43% occur in people living with HIV. Both resistance and HIV–tuberculosis co-infection lead to unfavourable tuberculosis treatment outcomes. In this case series, we followed up eight HIV–tuberculosis co-infected patients withdrawn from a pharmacokinetics study on anti-tuberculosis drugs between April 2013 and April 2015 following a diagnosis of drug-resistant tuberculosis. We identified resistance patterns and treatment regimens and evaluated their tuberculosis treatment outcomes. Two patients were multidrug-resistant, only one out of eight was treated according to the World Health Organization guidelines applicable at that time and five had unfavourable tuberculosis treatment outcomes, that is, were lost to follow-up, could not be evaluated or died. Taken together, we found unfavourable tuberculosis treatment outcomes for patients with drug-resistant tuberculosis. This indicates the necessity of implementation of current treatment guidelines and close monitoring for patients with drug-resistant tuberculosis.
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Author's reply Sir—The high transmission rate of multidrug-resistant tuberculosis among new (62%) and previously treated (66%) patients, shows that infection or reinfection with a multidrug-resistant strain of tuberculosis was important in the area studied. We concluded that further studies in areas with high and low incidence are needed. Kathy DeRiemer and colleagues report a low proportion of transmission among new (16·6%) and re-treated multidrug-resistant tuberculosis cases (15%) in Mexico. Pamela Sonnenberg and colleagues report a negative association of multidrug-resistant tuberculosis with clustering in patients working in South Africa Goldmines. Quantitative differences from various communities illustrate the importance of not extrapolating results obtained in only one setting at a single time period. We agree that differences in results can be explained by differences in study design, tuberculosis prevalence, multidrug resistant outbreaks, virulence of circulating strains, and transmission rates of local M tuberculosis strains, as expressed by cluster number and size. Other factors, such as policy (timing) of drug resistance testing and treatment strategies for multidrug-resistant tuberculosis also affect transmission rates. Patients with primary resistant tuberculosis who are still culture positive after 1 month and only then undergo drug-resistance testing will be misclassified as having acquired drug resistance. If these patients are not correctly treated, they will remain infectious for long periods of time and will increase the proportion of transmission of multidrug-resistant tuberculosis in the community. Sonnenberg notes that inclusion of a large cluster and laboratory contamination might have altered the data. We reanalysed our data after eliminating the largest cluster of multidrug-resistant cases. Of the remaining 28 such cases, 17 (61%) were infected with an isolate belonging to a cluster varying in size from three to eight cases. The proportion of transmission remained high among new and previously treated multidrug-resistant cases (43% and 48% respectively). Removal of a large cluster from the study cannot, however, be justified since it will bias the study and change reality. Cross-contamination is unlikely to have contributed to the estimates, because only ten of the 39 clustered cases had a single restriction-fragment length polymorphism analysis. Of these, nine had multiple positive cultures. The one patient with a single positive culture was smear positive and had radiological evidence of active tuberculosis. The alternative definition for a cluster was used to avoid the inclusion of transmission of a drug-sensitive isolate with subsequent development of drug resistance, and, thus, to avoid overestimation of the rate of transmission of multidrug-resistant tuberculosis. We agree that this debate on classification of drug resistance should not detract from ensuring that patients adhere to treatment. Nevertheless, an important conclusion of these studies remains that surveillance data based on history of previous treatment are insufficient to predict drug resistance, to predict transmission patterns of multidrug resistance, and to correctly assess a tuberculosis control programme. Classification of drug resistant tuberculosisAnnelies van Rie and colleagues (July 1, p 22)1 suggest that, in an epidemic area, a large proportion of tuberculosis drug resistance traditionally classified as acquired may be due to recent transmission. Full-Text PDF Classification of drug resistant tuberculosisAnnelies van Rie and colleagues1 call for adoption of new terminology to refer to drug resistance in previously treated cases and drug resistance in new cases. Their data have, however, limited inference to other geographical areas and epidemiological settings. Full-Text PDF
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[Objective] To determine the difference in drug resistance of M.tuberculosis(TB) between resident TB cases and migrant TB cases on data from Putuo Central Hospital. [Methods] There were 598 migrants and 600 residents included and the latter were as control group.Proportional method with Lwenstein-Jensen culture medium was used for susceptibility test on 4 antituberculosis drugs. [Results] Total drug resistance rate in 598 smear-positive migrant TB cases was 28.3%,of which the rates of first treated and re-treated patients were 19.6% and 48.5% respectively,and the total cure rate was 84.6%.Total drug resistance rate in 600 smear-positive resident TB cases was 23.2%,of which the rates of first treated and re-treated patients were 15% and 41.3% respectively,and the total cure rate was 87.0%.There was no significant difference in total drug resistance rates between the two groups.The drug resistance in migrant TB cases,both male or female,was higher than that in resident TB cases.The drug-fast cases in initial treatment among residents and migrants were both mainly single drug fast cases,while most of those in re-treatment were nearly multitude drug fast cases.Most of the drug fast cases in migrants were youths,while most of those in residents were old men. [Conclusion] The rates of drug resistance were found to be high in both migrant and resident TB cases.So up-to-date TB control program must be implemented continuously to decrease the occurrence of drug resistance in tuberculosis.
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Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis, which threats the health of children worldwide.Accompany with the increase of drug-resistance tuberculosis, great challenging has arose in the prevention and treatment of tuberculosis.Nowadays, the diagnosis and treatment of drug-resistance tuberculosis is still difficult in pediatric patients.Based on molecular diagnosis, fast detect as well as reliable treatment of drug-resistance tuberculosis become available.Currently, the principle of drug-resistant tuberculosis treatment in children is essentially similar to adults.In this review, the mechanism, diagnosis and treatment of pediatric drug resistance tuberculosis were discussed.
Key words:
Child; Drug-resistance tuberculosis; Prevalence; Mechanisms of drug-resistance; Diagnosis; Treatment
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Objective To xinzhou city drug-resistant TB causes and trends are analyzed,and puts forward relevant measures.Methods Select our 2007 October to December 2009,between 100 patients do n/med tuberculosis bacterium drug sensitivity tests of patients,the patients of total resistance and 3 years total resistance changes of statistics.Results 100 patients,drug-resistant seventy-one patients,total resistance for 71%,including single drug resistance,resistance to many medicine rate 22% rate 49%.2007 resistant 69 percent in 2008,2009 resistant 71 percent rate at 73%,resistance is increased year by year trend.Conclusions With chemical drug problems such as unreasonable application,resulting in zhuhai drug-resistant TB increasing year by year,drugresistant TB also shows ascendant trend.Completes drug-resistant TB prevention and treatment is currently the top priority of our work.
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Background. Multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis remain severe epidemic problems in the world. That’s why the purpose of our study was to investigate the dynamics of the incidence of multidrug-resistant and extensively drug-resistant tuberculosis, the structure of cases and the effectiveness of treatment in this category of patients in the Kharkiv region and in Ukraine.
Materials and methods. To perform the study, data from reporting forms No. 4-2 (TB 07 – MDR TB), No. 8-6 (TB 08) and data from analytical and statistical reference books “Tuberculosis in Ukraine” were used. Statistical processing of information was carried out using Statistica 7.0, Microsoft Office Excel 2007.
Results. We found a relatively consistently high incidence rate, prevalence of tuberculosis recurrences among patients with drug-resistant tuberculosis, an increase in the proportion of extensively-drug resistance in patients with treatment failure and interrupted treatment, and low effectiveness of treatment of multidrug-resistant and extensively drug-resistant tuberculosis in patients with repeated cases of treatment.
Conclusions. The obtained data once again emphasizes the need for the selection of adequate schemes for antituberculosis chemotherapy and control of anti-tuberculosis drugs.
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