775. An Epidemiological Analysis of Patients With Multidrug-Resistant Tuberculosis Among Tibetan Refugees in India

Abstract Background Globally, refugee populations face an increased risk for tuberculosis (TB) due to malnutrition, overcrowding, and poor living conditions. Compared with the general Indian population, Tibetan refugees in India display a higher incidence rate of both TB and multidrug-resistant TB (MDR-TB). The high incidence of MDR-TB in younger population is a serious public health concern. Methods We retrospectively reviewed the medical records of patients with MDR-TB treated from January 2010 to December 2013 in Tibetan Delek Hospital, which is the center of TB control among Tibetan refugees. Patients were classified into either new cases (supposed infection by exposure to MDR-TB) or previously treated MDR-TB cases (suspected acquirement of MDR-TB through anti-TB treatment or by MDR-TB exposure after treatment). We compared patients’ age, sex, birthplace, residence type, occupation, contact history, and treatment outcome. Results Of 749 patients with TB, we enrolled 134 patients with MDR-TB [median age, 26 (interquartile range: 22–35) years; males, 55%]. The Tibetan ethnicity comprised 96% of the study population, whereas Indians (trans-Himalayan) comprised 4%. The birthplace was Tibet for 22% patients, India for 75%, and Nepal for 2%. New MDR-TB cases were 28% and previously treated MDR-TB cases were 72%. Failure was observed in 42% patients and cured and completed in 54% patients, during their previous TB treatment. The median age was significantly lower in new cases than in previously treated MDR-TB cases (24 vs. 28.5 years; P < 0.01). Tibet was the birthplace of 34% new cases and 18% in previously treated cases (P = 0.04). The residence was of the congregated type in 58% of new cases and 30% in previously treated MDR-TB cases (P = 0.01). The occupation was “student” and “unemployed” in 58% and 8% in new cases and 33% and 24% in previously treated cases, respectively (P = 0.03). Contact history with TB type and treatment outcome were not considerably different, although the rates of cured and completed were high in both new (82%) and previously treated (84%) MDR-TB cases. Conclusion This study shows that new MDR-TB correlates with younger age, birth in Tibet, congregated residence, and student occupation. Targeting the above-listed characteristics could be effective in further reducing the MDR-TB transmission among Tibetan refugees in India. Disclosures All authors: No reported disclosures.

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Multidrug-resistant tuberculosis (MDR-TB) and multidrug-resistant HIV (MDR-HIV) syndemic: challenges in resource limited setting

BMJ Case Reports ◽

10.1136/bcr-2019-230628 ◽

2019 ◽

Vol 12 (8) ◽

pp. e230628 ◽

Cited By ~ 1

Author(s):

Christian Francisco ◽

Mary Ann Lansang ◽

Edsel Maurice Salvana ◽

Katerina Leyritana

Keyword(s):

Psoas Abscess ◽

Multidrug Resistant ◽

Health Concern ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Resource Limited ◽

Persons Living With Hiv ◽

Mdr Tb ◽

Living With Hiv

Tuberculosis (TB) is common among persons living with HIV. This public health concern is aggravated by infection with multidrug-resistant organisms and adverse effects of polypharmacy. There are few published cases of multidrug-resistant tuberculosis (MDR-TB) in multidrug-resistant HIV (MDR-HIV) infected patients. We report a case of a 29-year-old Filipino man with HIV on zidovudine (AZT)-containing antiretroviral therapy (ART) but was eventually shifted to tenofovir due to anaemia. He presented with left flank tenderness, which was found to be due to an MDR-TB psoas abscess, and for which second-line anti-TB treatment was started. HIV genotyping showed MDR-HIV infection susceptible only to AZT, protease inhibitors and integrase inhibitors. Subsequently, he developed neck abscess that grew Mycobacterium avium complex and was treated with ethambutol and azithromycin. ART regimen was revised to AZT plus lamivudine and lopinavir/ritonavir. Erythropoietin was administered for recurrent AZT-induced anaemia. Both abscesses resolved and no recurrence of anaemia was noted.

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Increasing multidrug-resistant tuberculosis in Ho Chi Minh City: a retrospective study of 2,266 cases from 2011 to 2015

10.21203/rs.2.12034/v2 ◽

2019 ◽

Author(s):

Le Hong Van ◽

Phan Trieu Phu ◽

Dao Nguyen Vinh ◽

Vo Thanh Son ◽

Nguyen Thi Hanh ◽

...

Keyword(s):

Risk Factors ◽

Treatment Outcome ◽

Multidrug Resistant ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Poor Treatment ◽

Mdr Tb ◽

Poor Outcomes ◽

Poor Treatment Outcome

Abstract Background: Multidrug resistant tuberculosis (MDR-TB) remains a serious public health problem with poor treatment outcome. Predictors of poor outcomes vary in different regions. Vietnam is among the 30 countries with high burden of MDR-TB. We aim to describe demographic characteristics and identify risk factors for poor outcome of MDR-TB in Ho Chi Minh City (HCMC), the most populous city in Vietnam. Methods: This retrospective study included 2,266 patients who initiated MDR-TB treatment from 2011 to 2015 in HCMC. Treatment outcomes were available in 2,240 patients. Data was collected from standardized paper-based treatment cards and electronic records. Kruskal Wallis test was used to diagnose the change of median of age and body mass index (BMI) over 5 years, and Wilcoxon test to compare median BMI of patients with and without diabetes mellitus. Chi squared test was used to compare categorical variables. Multivariate logistic regression on multiple imputation was used to identify risk factors for poor outcomes. Statistical analysis was performed using R program. Results: Among 2,266 eligible cases, 60.2% were failure of category I or II regimen, 57.7% were underweight, 30.2% had diabetes mellitus and 9.6% were HIV positive. Notification rate increased 24.7% from 2011 to 2015.Treatment success rate was 73.3%. Risk factors for poor treatment outcome included HIV co-infection (adjusted odds ratio (aOR): 2.94), advanced age (aOR: 1.45 for every increase of 5 years for patients 60 years or older), having history of MDR-TB treatment (aOR: 5.53), sputum smear grade scanty and 1+ (aOR: 1.47), smear grade 2+ or 3+ (aOR: 2.06), low BMI (aOR: 0.83 for every increase of 1kg/m2 of BMI for patients with BMI<21). Conclusion: Our study describes the increasing cases of MDR-TB in HCMC during 2011 to 2015. Patients with HIV, high smear grade, malnutrition and history of previous MDR-TB treatment should receive additional care. Keywords: multidrug resistant tuberculosis; retrospective; treatment outcome; risk factors; Vietnam

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Different profiles of body mass index evolutions among patients with multidrug-resistant tuberculosis: a retrospective cohort study.

10.21203/rs.2.16913/v1 ◽

2019 ◽

Author(s):

Alhassane Diallo ◽

Boubacar Djelo Diallo ◽

Lansana Mady Camara ◽

Lucrèce Ahouéfa Nadège Kounoudji ◽

Boubacar Bah ◽

...

Keyword(s):

Body Mass Index ◽

Treatment Outcome ◽

Body Mass ◽

Mixed Model ◽

Multidrug Resistant ◽

The Body ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb

Abstract Background Despite the predictor role of the body weight variation on multidrug-resistant tuberculosis (MDR-TB) treatment outcome, little data are available to corroborate this finding. We aimed to study the course of weight in patients with MDR-TB, to identify subgroups of weight evolutions, and to determine factors that influence these evolutions.Methods Patients treated with a shorter MDR-TB treatment regimen between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centres in Guinea, who had rifampicin resistance, and who were cured or died were analysed. Patients were seen monthly until the end of treatment. Clinical outcome was the Body Mass Index (BMI). We used a linear mixed model to analyze the course of BMI and a latent class mixed model to identify subgroup of BMI evolutions.Results Of 232 patients treated for MDR-TB during the study period, 165 (71%) were analysed. These patients had a total of 1387 visits, with a median of 5 visits (interquartile range, 3 – 8 visits). Monthly BMI increase was 0.24 (SE 0.02) per kg/m 2 . Factors that associated with faster BMI progression were cured to MDR-TB treatment (0.24 [SE 0.09] per kg/m 2 ; p = 0.0205), and the absence of lung cavities on X-ray (0.18 [0.06] per kg/m 2 ; p = 0.0068). Two subgroups of BMI evolution were identified: “Rapid BMI (n = 121; 85%) and “Slow BMI evolution (n = 22; 15%). Patients in the slow increasing BMI group were mostly female (68%) without history of TB treatment (41%) with most severe clinical condition at baseline, characterized by a higher frequency of symptoms including HIV infection (59%), depression (18%), dyspnea (68%), poor adherence to MDR-TB treatment (64%), lower platelets count, and higher liver SGOT count. These patients had also a longer time to-initial culture conversion delay (log-rank test: p = 0.0087).Conclusion The available data provide quantitative information on BMI progression of patients with MDR-TB treated with a shorter regimen, and allowed the identification of the subgroup of patients with different BMI evolutions. Furthermore, they emphasize the usefulness of BMI as biomarker to monitor MDR-TB treatment outcome.

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Primary Clofazimine and Bedaquiline Resistance among Isolates from Patients with Multidrug-Resistant Tuberculosis

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00239-17 ◽

2017 ◽

Vol 61 (6) ◽

Cited By ~ 47

Author(s):

Jian Xu ◽

Bin Wang ◽

Minghao Hu ◽

Fengmin Huo ◽

Shaochen Guo ◽

...

Keyword(s):

Multidrug Resistant ◽

Cross Resistance ◽

Drug Resistant ◽

Content Type ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb ◽

Previously Treated ◽

Alamarblue Assay

ABSTRACT Clofazimine has been repurposed for the treatment of tuberculosis, especially for multidrug-resistant tuberculosis (MDR-TB). To test the susceptibility to clofazimine of Mycobacterium tuberculosis clinical isolates, MICs of clofazimine were determined using the microplate alamarBlue assay (MABA) method for 80 drug-resistant isolates and 10 drug-susceptible isolates for comparison. For five clofazimine-resistant strains isolated from previously treated pre-extensively drug-resistant TB (pre-XDR-TB) and XDR-TB patients without prior exposure to clofazimine or bedaquiline, clofazimine MICs were ≥1.2 μg/ml. Four isolates with cross-resistance to bedaquiline had Rv0678 mutations. The other isolate with no resistance to bedaquiline had an Rv1979c mutation. This study adds to a recent study showing that 6.3% of MDR-TB patients without prior clofazimine or bedaquiline exposure harbored isolates with Rv0678 mutations, which raises concern that preexisting resistance to these drugs may be associated with prior TB treatment. Furthermore, we propose a tentative breakpoint of 1.2 μg/ml for clofazimine resistance using the MABA method. More-widespread surveillance and individualized testing for clofazimine and bedaquiline resistance, together with assessment of their clinical usage, especially among previously treated and MDR-TB patients, are warranted.

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Different profiles of body mass index variation among patients with multidrug-resistant tuberculosis: a retrospective cohort study.

10.21203/rs.2.16913/v4 ◽

2020 ◽

Author(s):

Alhassane Diallo ◽

Boubacar Djelo Diallo ◽

Lansana Mady Camara ◽

Lucrèce Ahouéfa Nadège Kounoudji ◽

Boubacar Bah ◽

...

Keyword(s):

Body Mass Index ◽

Treatment Outcome ◽

Body Mass ◽

Mixed Model ◽

Multidrug Resistant ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Weight Variation ◽

Mdr Tb

Abstract Background: Despite the predictive role of body weight variation in treatment outcome in multidrug-resistant tuberculosis (MDR-TB), few corroborating data are available. We studied weight variation in patients with MDR-TB to identify groups of weight change and to determine factors that influence these changes. Methods: We analyzed patients with rifampicin resistance who were treated with an MDR-TB treatment regimen between June 07, 2016 and June 22, 2018 at three major drug-resistant TB centers in Guinea. Patients were seen monthly until the end of treatment. Clinical outcome was the body mass index (BMI). We used a linear mixed model to analyze trajectories of BMI and a latent class mixed model to identify groups of BMI trajectories. Results: Of 232 patients treated for MDR-TB during the study period, 165 were analyzed. These patients had a total of 1387 visits, with a median of 5 visits (interquartile range, 3 – 8 visits). Monthly BMI increase was 0.24 (SE 0.02) per kg/m 2 . Factors associated with faster BMI progression were success of MDR-TB treatment (0.24 [SE 0.09] per kg/m 2 ; p = 0.0205) and absence of lung cavities on X-ray (0.18 [0.06] per kg/m 2 ; p = 0.0068). Two groups of BMI change were identified: rapid BMI increase (n = 121; 85%) and slow BMI increase (n = 22; 15%). Patients in the slow BMI increase group were mostly female (68%) had no history of TB treatment (41%), had a positive HIV infection (59%), and had a more severe clinical condition at baseline, characterized by a higher frequency of symptoms including depression (18%), dyspnea (68%), poor adherence to MDR-TB treatment (64%), lower platelet count, and higher SGOT. These patients also had a longer time to initial culture conversion (log-rank test: p = 0.0087). Conclusion: Quantitative BMI data on patients with MDR-TB treated with a short regimen allowed the identification of subgroups of patients with different trajectories of BMI and emphasized the usefulness of BMI as a biomarker for the monitoring of MDR-TB treatment outcome.

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Effect of reliance on Xpert MTB/RIF on time to treatment and multidrug-resistant tuberculosis treatment outcomes in Tanzania: a retrospective cohort study

International Health ◽

10.1093/inthealth/ihz005 ◽

2019 ◽

Vol 11 (6) ◽

pp. 520-527 ◽

Cited By ~ 3

Author(s):

Edson Mollel ◽

Isack Lekule ◽

Lutgarde Lynen ◽

Tom Decroo

Keyword(s):

Cohort Study ◽

Treatment Outcome ◽

Treatment Outcomes ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Multidrug Resistant ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Unsuccessful Treatment ◽

Mdr Tb

Abstract Background During 2009–2013, Xpert MTB/RIF testing was decentralized in Tanzania. Standardized treatment of multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) was centralized at the Kibong’oto Infectious Diseases Hospital. Initially, Xpert MTB/RIF results were confirmed and complemented with phenotypic drug susceptibility testing before MDR-TB treatment was started. Since 2013, the decision to start MDR-TB treatment in patients with RR-TB relied on Xpert MTB/RIF results. Methods A retrospective cohort study of predictors of unsuccessful treatment outcomes (including death, lost to follow-up and treatment failure) was carried out. Results During the study period, 201 patients started MDR-TB treatment. The number of patients starting MDR-TB treatment increased over time. Out of 201 patients, 48 (23.9%) had an unsuccessful treatment outcome. The median time between sample collection and MDR-TB treatment initiation was reduced from 155 d (IQR 40–228) in the 2009–2012 period to 26 d (IQR 13–64) in 2013. Patients who started MDR-TB treatment in 2013 were more likely (adjusted OR 2.3; 95% CI 1.1–4.7; p=0.02) to have an unsuccessful treatment outcome. Conclusions Xpert MTB/RIF testing increased enrolment on MDR-TB treatment. Reliance on Xpert MTB/RIF results to start MDR-TB treatment reduced time to treatment. However, treatment outcomes did not improve.

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Determination of MIC Breakpoints for Second-Line Drugs Associated with Clinical Outcomes in Multidrug-Resistant Tuberculosis Treatment in China

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.03008-15 ◽

2016 ◽

Vol 60 (8) ◽

pp. 4786-4792 ◽

Cited By ~ 14

Author(s):

Xubin Zheng ◽

Rongrong Zheng ◽

Yi Hu ◽

Jim Werngren ◽

Lina Davies Forsman ◽

...

Keyword(s):

Treatment Outcome ◽

Treatment Success ◽

Multidrug Resistant ◽

Classification And Regression Tree ◽

Second Line ◽

Cart Analysis ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb

ABSTRACTOur study aims to identify the clinical breakpoints (CBPs) of second-line drugs (SLDs) above which standard therapy fails in order to improve multidrug-resistant tuberculosis (MDR-TB) treatment. MICs of SLDs were determined forM. tuberculosisisolates cultured from 207 MDR-TB patients in a prospective cohort study in China between January 2010 and December 2012. Classification and regression tree (CART) analysis was used to identify the CBPs predictive of treatment outcome. Of the 207 MDR-TB isolates included in the present study, the proportion of isolates above the critical concentration recommended by WHO ranged from 5.3% in pyrazinamide to 62.8% in amikacin. By selecting pyrazinamide as the primary node (CBP, 18.75 mg/liter), 72.1% of sputum culture conversions at month four could be predicted. As for treatment outcome, pyrazinamide (CBP, 37.5 mg/liter) was selected as the primary node to predict 89% of the treatment success, followed by ofloxacin (CBP, 3 mg/liter), improving the predictive capacity of the primary node by 10.6%. Adjusted by identified confounders, the CART-derived pyrazinamide CBP remained the strongest predictor in the model of treatment outcome. Our findings indicate that the critical breakpoints of some second-line drugs and PZA need to be reconsidered in order to better indicate MDR-TB treatment outcome.

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Different profiles of body mass index evolutions among patients with multidrug-resistant tuberculosis: a retrospective cohort study.

10.21203/rs.2.16913/v2 ◽

2020 ◽

Author(s):

Alhassane Diallo ◽

Boubacar Djelo Diallo ◽

Lansana Mady Camara ◽

Lucrèce Ahouéfa Nadège Kounoudji ◽

Boubacar Bah ◽

...

Keyword(s):

Body Mass Index ◽

Treatment Outcome ◽

Body Mass ◽

Mixed Model ◽

Multidrug Resistant ◽

The Body ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb

Abstract Background: Despite the predictor role of the body weight variation on multidrug-resistant tuberculosis (MDR-TB) treatment outcome, little data are available to corroborate this finding. We aimed to study the course of weight in patients with MDR-TB, to identify subgroups of weight evolutions, and to determine factors that influence these evolutions. Methods: Patients treated with a shorter MDR-TB treatment regimen between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centers in Guinea, who had rifampicin resistance, and who were cured or died were analyzed. Patients were seen monthly until the end of treatment. Clinical outcome was the Body Mass Index (BMI). We used a linear mixed model to analyze the course of BMI and a latent class mixed model to identify subgroup of BMI evolutions. Results: Of 232 patients treated for MDR-TB during the study period, 165 were analyzed. These patients had a total of 1387 visits, with a median of 5 visits (interquartile range, 3 – 8 visits). Monthly BMI increase was 0.24 (SE 0.02) per kg/m 2 . Factors that associated with faster BMI progression were cured to MDR-TB treatment (0.24 [SE 0.09] per kg/m 2 ; p = 0.0205), and the absence of lung cavities on X-ray (0.18 [0.06] per kg/m 2 ; p = 0.0068). Two subgroups of BMI evolution were identified: “Rapid BMI (n = 121; 85%) and “Slow BMI evolution (n = 22; 15%). Patients in the slow increasing BMI group were mostly female (68%) without history of TB treatment (41%), with positive HIV infection (59%), with most severe clinical condition at baseline, characterized by a higher frequency of symptoms including depression (18%), dyspnea (68%), poor adherence to MDR-TB treatment (64%), lower platelets count, and higher liver SGOT count. These patients had also a longer time to-initial culture conversion delay (log-rank test: p = 0.0087). Conclusion: The available data provided quantitative information on BMI progression of patients with MDR-TB treated with a shorter regimen, and allowed the identification of the subgroup of patients with different BMI evolutions. Furthermore, they emphasized the usefulness of BMI as biomarker to monitor MDR-TB treatment outcome.

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Different profiles of body mass index variation among patients with multidrug-resistant tuberculosis: a retrospective cohort study.

10.21203/rs.2.16913/v3 ◽

2020 ◽

Author(s):

Alhassane Diallo ◽

Boubacar Djelo Diallo ◽

Lansana Mady Camara ◽

Lucrèce Ahouéfa Nadège Kounoudji ◽

Boubacar Bah ◽

...

Keyword(s):

Body Mass Index ◽

Treatment Outcome ◽

Body Mass ◽

Mixed Model ◽

Multidrug Resistant ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Weight Variation ◽

Mdr Tb

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National treatment outcome and predictors of death and treatment failure in multidrug-resistant tuberculosis in Ethiopia: a 10-year retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-040862 ◽

2021 ◽

Vol 11 (8) ◽

pp. e040862

Author(s):

Habteyes Tola ◽

K Holakouie-Naieni ◽

Mohammad Ali Mansournia ◽

Mehdi Yaseri ◽

Dinka Fikadu Gamtesa ◽

...

Keyword(s):

Treatment Outcome ◽

Treatment Failure ◽

Treatment Success ◽

Multidrug Resistant ◽

The Past ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb

ObjectivesTreatment success rate in patients treated for multidrug-resistant tuberculosis (MDR-TB) is low, but predictors of treatment failure and death have been under-reported. Thus, we aimed to determine the national proportion of treatment success rate in the past 10 years and factors that predict treatment failure and death in patients with MDR-TB in Ethiopia.SettingA retrospective cohort study with a 10-years follow-up period was conducted in 42 MDR-TB treatment-initiating centres in Ethiopia.ParticipantsA total of 3395 adult patients with MDR-TB who had final treatment outcome and who were treated under national TB programme were included. Data were collected from clinical charts, registration books and laboratory reports. Competing risk survival analysis model with robust standard errors (SE) was used to determine the predictors of treatment failure and death.Primary and secondary outcomesTreatment outcome was a primary outcome whereas predictors of treatment failure and death were a secondary outcome.ResultsThe proportion of treatment success was 75.7%, death rate was 12.8%, treatment failure was 1.7% and lost to follow-up was 9.7%. The significant predictors of death were older age (adjusted hazard ratio (AHR)=1.03; 95% CI 1.03 to 1.05; p<0.001), HIV infection (AHR=2.0; 95% CI 1.6 to 2.4; p<0.001) and presence of any grade of anaemia (AHR=1.7; 95% CI 1.4 to 2.0; p<0.001). Unlike the predictors of death, all variables included into multivariable model were not significantly associated with treatment failure.ConclusionIn the past 10 years, although MDR-TB treatment success in Ethiopia has been consistently favourable, the proportion of patients who died is still considerable. Death could be attributed to advanced age, HIV infection and anaemia. Prospective cohort studies are necessary to further explore the potentially modifiable predictors of treatment failure.

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