Drug Resistant Tuberculosis in the Northern Region of Zambia: A Retrospective Study
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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.Keywords:
Drug resistant tuberculosis
The occurance and prevalence of multidrug-resistant tuberculosis poses a serious threat to the global tuberculosis control. Ethambutol (EMB) is one of the first-line anti-tuberculosis drugs, which is usually used in combination with isoniazid and rifampicin for treating pan-sensitive tuberculosis, and it can also be used in drug-resistant tuberculosis. However, the situation of EMB resistance is alarmingly high, especially in multi-drug resistant tuberculosis. In China, EMB resistance rate in the previously treated cases was up to 17.2% and showed an increased tendency. What was worse, 51.3%-66.7% of multidrug-resistant tuberculosis cases were resistant to EMB. Thus, it is important to understand the drug resistance mechanism of EMB, which will help to slow down the drug resistance rate of EMB. In this review, we focus on the current status of EMB resistance, the effects of EMB and the mechanisms of EMB resistance in Mycobacterium tuberculosis.
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Drug resistance surveillance is a useful tool to assess the effective functioning of tuberculosis (TB) control program. This study was undertaken to know the first line anti tuberculosis drug susceptibility profile of Mycobacterium tuberculosis clinical isolates from the Gulbarga district of South India. Drug susceptibility test was performed for 102 clinical isolates of M. tuberculosis belonging to new (n = 62), treated (n = 22) and unknown treatment category (n = 18) of TB. All the isolates were tested for susceptibility to first line anti-tuberculosis drugs by minimum inhibitory concentration (MIC) and resistance ratio method (for streptomycin). The susceptibility profile of M. tuberculosis to all five first line anti-tubercular drugs was found to be 60.78% (62/102). Overall, multi drug resistance (resistance to at least isoniazid and rifampicin) was observed in 8.82% (9/102) isolates and was found to be higher for treated cases (18.18%). High level of drug resistance observed in new cases for isoniazid, rifampicin and ethambutol suggests need for the implementation of drug resistance surveillance studies in order to document the success of the tuberculosis control program in reducing the level of drug resistance.
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Objective To analyze the drug resistance of antibiotics frequently used for treating tuberculosis in Yueyang in recent two years,and to provide the evidence for tuberculosis controlling.Methods The patients infected with Mycobacterium tuberculosis(MTB) diagnosed in Yueyang from January,2009 to December,2010 were enrolled in this study.Absolute concentration method was used to test the drug-resistance of isoniazide(INH),rifampicin(RFP),streptomycin(SM),and ethambutol(EMB).Results Among 205 patients infected with MTB,the total rates of drug resistance and multi-drug resistance were 32.7% and 18.8%,respectively.The rates of initial drug resistance and acquired drug resistance were 21.3% and 63.6%,respectively.The acquired multidrug-resistant rate was 38.2%,which was significantly higher than that of initial multidrug-resistant rate(10.7%).Conclusions The drug resistant status of tuberculosis is still serious in Yueyang,and we should further monitor and control the drug resistance of antibiotics in treating tuberculosis.
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Objective To understand the status on drug resistance of mycobacterium tuberculosis in Sichuan,and to provide the evidence for tuberculosis treatment and control.Methods The tuberculosis patients were investigated by face to face interview and the clinical isolates of patients were collected.Mycobacterium tuberculosis were identified,and absolute concentration method was used to test the drug-resistance of isoniazide(INH),rifampicin(RFP),streptomycin(SM),ethambutol(EMB).The status on drug resistance of mycobacterium tuberculosis were analyzed.Results The total rate of drug resistance and the rate of multi-drug resistance were respectively 21.39% and 11.35%,and there was statistical significance between the total rate of drug resistance and multi-drug resistance of primary treatment patients and that of re-treatment patients.Conclusions There is a decrease in the drug resistant status of Sichuan,but it is still an importance of tuberculosis control and prevention,and we should further strengthen on its surveillance and control.
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Drug resistant tuberculosis (DR-TB) is a serious health issue worldwide and a number of mechanisms have been suggested which are involved in developing resistance in Mycobacterium tuberculosis to anti-tuberculosis drugs. In the Indian perspective, the pattern and prevalence of drug-resistant tuberculosis (DR-TB) are heterogeneous across regions and settings. Notably, isoniazid (INH), rifampicin (RIF) and ethambutol (EMB) are the most effective drugs in tuberculosis therapy. Understanding the pattern of resistance to these drugs in the Indian population is essential in quick diagnosis of multidrug-resistant (MDR) tuberculosis and extensive DR-TB (XDR-TB). A total of 36 Mycobacterium isolates from the North Indian population were exposed and tested for drug susceptibility with INH, RIF and EMB in vitro and results showed that 25, 24 and 24 isolates were resistant to INH, RIF and EMB respectively. Gene expression analysis revealed that approximately 50% of isolates under the stress of these three anti-tuberculosis drugs showed overexpression of efflux gene Rv1634. Moreover, overexpression of gene Rv1634 contributes to the emergence of drug resistance in M. tuberculosis and inhibition of Rv1634 along with other efflux pump genes and may provide a promising strategy for improving tuberculosis treatment outcomes in North India.
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Tuberculosis was one of most serious infectious diseases that were harmful to human health.Antibiotics was effective treatment against this bacterium.But the emergency of multi-and extensively drug-resistant Mycobacterium tuberculosis(Mtb) were occurred frequently when the use of antibiotics was unproper.Drug-resistant phenotype was due to mutations in drug resistant related genes,this paper will state the progress in mechanism study of drug resistant Mtb,which will guide the diagnosis and treatment of drug resistant Mtb.
Drug resistant tuberculosis
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The objective of this study was to observe the prevalence of drug resistance in Mycobacterium tuberculosis isolates in HIV associated tuberculosis co-infected patients in Phnom Penh City. The isolates of M. tuberculosis were collected during active laboratory-based surveillance. Of the 98 isolates studied, M. tuberculosis resistance to isoniazid was seen in 23.5%, resistance to rifampicin was seen in 16.3% and multidrug-resistance (MDR-TB) was seen in 5.1%. Our findings reveal an alarmingly high level of resistance to isoniazid and rifampicin, and confirms the need for drug susceptibility testing to guide treatment in patients with culture positive tuberculosis.
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