Early results of systematic drug susceptibility testing in pulmonary tuberculosis retreatment cases in Cameroon

The report of a case of tuberculous meningitis developing during the course of chemotherapy for pulmonary tuberculosis, by Lintermans and Seyhnaeve,1 illustrates the importance of drug susceptibility testing of the infecting organism. Initial cultures isolated from the gastric washings in this case were not tested for drug susceptibility, but subsequent cultures isolated from the spinal fluid after 33½ months of therapy proved to be isoniazid resistant. The authors state that "this complication (meningitis) developed despite specific chemotherapy and corticosteroids for active pulmonary tuberculosis."

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Phenotypic characterisation and drug sensitivity testing of mycobacteria isolated from extra-pulmonary tuberculosis

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i1.3223 ◽

1970 ◽

Vol 8 (1) ◽

pp. 57-61 ◽

Cited By ~ 3

Author(s):

R Gurung ◽

SK Bhattacharya ◽

B Pradhan ◽

S Gurung ◽

YI Singh

Keyword(s):

Developing Countries ◽

Drug Resistance ◽

Pulmonary Tuberculosis ◽

Susceptibility Testing ◽

Drug Susceptibility ◽

Drug Susceptibility Testing ◽

Phenotypic Characterization ◽

Extra Pulmonary Tuberculosis ◽

Extra Pulmonary

Background: Tuberculosis (TB) is a major cause of morbidity and mortality globally, with most cases occurring in developing countries. The importance of extra pulmonary tuberculosis (EPTB) among all forms of tuberculosis has not yet been ascertained in developing countries Objective: To identify and perform phenotypic characterization of clinically important mycobacterium isolates from extra-pulmonary sites along with drug susceptibility testing. Materials and methods: A total of 513 specimens from patients of (EPTB) with varied presentation were studied. Speciation and characterization of isolates were done on the basis of growth and biochemical characteristics. Drug susceptibility testing for mycobacterium isolates was done by proportion method. Results: Fifty four patients clinically suspected to have extra-pulmonary tuberculosis were culture positive for mycobacteria. On characterization 48 of the 54 isolates were identified as M. tuberculosis, 4 as M. bovis and 2 were M. avium/ intracelulare. Drug susceptibility testing was done for the both M. tuberculosis as well as M. bovis. In single drug resistance, Streptomycin was highest followed by Isoniazid, Ethambutol and Refampicin. Multi drug resistance (MDR) was found in 6 isolates and it was observed only in group I cases. Conclusion: EPTB accounts for 10-15 percent of all cases of tuberculosis. Mycobacterium was present in 10.5 percent samples. 48 isolates out of 54 samples were found to be M. tuberculosis. The maximum numbers of M. tuberculosis were isolated from lymph node aspiration. Key words: Phenotypic characterization; drug susceptibility; extra pulmonary tuberculosis DOI: 10.3126/kumj.v8i1.3223 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 57-61

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FAST tuberculosis transmission control strategy speeds the start of tuberculosis treatment at a general hospital in Lima, Peru

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.422 ◽

2021 ◽

pp. 1-7

Author(s):

Dylan B. Tierney ◽

Eli Orvis ◽

Ruvandhi R. Nathavitharana ◽

Shelley Hurwitz ◽

Karen Tintaya ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

General Hospital ◽

Susceptibility Testing ◽

Drug Susceptibility ◽

Drug Susceptibility Testing ◽

Tuberculosis Treatment ◽

Drug Resistant ◽

Historical Cohort ◽

Tuberculosis Transmission ◽

Resistant Tuberculosis

Abstract Objective: To evaluate the effect of the FAST (Find cases Actively, Separate safely, Treat effectively) strategy on time to tuberculosis diagnosis and treatment for patients at a general hospital in a tuberculosis-endemic setting. Design: Prospective cohort study with historical controls. Participants: Patients diagnosed with pulmonary tuberculosis during hospitalization at Hospital Nacional Hipolito Unanue in Lima, Peru. Methods: The FAST strategy was implemented from July 24, 2016, to December 31, 2019. We compared the proportion of patients with drug susceptibility testing and tuberculosis treatment during FAST to the 6-month period prior to FAST. Times to diagnosis and tuberculosis treatment were also compared using Kaplan-Meier plots and Cox regressions. Results: We analyzed 75 patients diagnosed with pulmonary tuberculosis through FAST. The historical cohort comprised 76 patients. More FAST patients underwent drug susceptibility testing (98.7% vs 57.8%; OR, 53.8; P < .001), which led to the diagnosis of drug-resistant tuberculosis in 18 (24.3%) of 74 of the prospective cohort and 4 (9%) of 44 of the historical cohort (OR, 3.2; P = .03). Overall, 55 FAST patients (73.3%) started tuberculosis treatment during hospitalization compared to 39 (51.3%) controls (OR, 2.44; P = .012). FAST reduced the time from hospital admission to the start of TB treatment (HR, 2.11; 95% CI, 1.39–3.21; P < .001). Conclusions: Using the FAST strategy improved the diagnosis of drug-resistant tuberculosis and the likelihood and speed of starting treatment among patients with pulmonary tuberculosis at a general hospital in a tuberculosis-endemic setting. In these settings, the FAST strategy should be considered to reduce tuberculosis transmission while simultaneously improving the quality of care.

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