Mortality and associated factors of patients with extensive drug-resistant tuberculosis: an emerging public health crisis in China

Background: Tuberculosis is the most common cause of death from an infectious disease worldwide after HIV/AIDS. Drug resistant tuberculosis continues to be a public health crisis. India stands, one among 27 “high burden” MDR countries and has over 2 million new TB cases every year and TB kill’s nearly 1000 people every day. The WHO 2018 Global Tuberculosis Report estimated that, worldwide, approximately 3.5 percent of all new TB cases and 18 percent of previously treated cases are caused by MDR or rifampicin-mono resistant strains.Methods: Presumptive drug resistance TB cases were subjected for CBNAAT or LPA to detect resistance patterns. About 231 cases of MDR/RR TB cases after pre-treatment evaluation started on CAT- IV regimen and both interim and final outcomes were analyzed.Results: Out of 231cases 172(74.4%) were males and 59(25.6%) were females with age between 13-75yrs. Total of 194 cases culture conversion occurred out of which 28 cases the cultures were reverted back to positives. Final Outcomes were, cured in 84 (36.3%) cases, treatment completed in 42 (18.18%) cases, defaulters in 31 (13.4%) cases, turned to be XDR in 10 (4.32%) cases, treatment failure in 10 (4.32%) cases, 50 (21.6%) cases died, 3(1.29%) cases were transferred out.Conclusions: Approximately 2/3rd of MDR/RR TB cases are retreatment sputum positive cases. Successful outcome observed in 54.54% of cases only. High rates of deaths and defaulters alarm the necessity of more effective implementation and surveillance of the programme.

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Drug-resistant tuberculosis: issues in epidemiology and challenges for public health

Tubercle and Lung Disease ◽

10.1016/0962-8479(94)90075-2 ◽

1994 ◽

Vol 75 (5) ◽

pp. 321-323 ◽

Cited By ~ 20

Author(s):

H.L. Rieder

Keyword(s):

Public Health ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis

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Public health and hospital‐based nursing intersection: Case study of drug‐resistant tuberculosis patients

Public Health Nursing ◽

10.1111/phn.13042 ◽

2022 ◽

Author(s):

Elize Pietersen ◽

Kim Anderson ◽

Yuri F. Heijden

Keyword(s):

Public Health ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Tuberculosis Patients ◽

Resistant Tuberculosis

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Pre-detection history of extensively drug-resistant tuberculosis in KwaZulu-Natal, South Africa

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1906636116 ◽

2019 ◽

Vol 116 (46) ◽

pp. 23284-23291 ◽

Cited By ~ 1

Author(s):

Tyler S. Brown ◽

Lavanya Challagundla ◽

Evan H. Baugh ◽

Shaheed Vally Omar ◽

Arkady Mustaev ◽

...

Keyword(s):

Public Health ◽

Public Health Surveillance ◽

Health Surveillance ◽

Whole Genome ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant ◽

Kwazulu Natal ◽

History Of

Antimicrobial-resistant (AMR) infections pose a major threat to global public health. Similar to other AMR pathogens, both historical and ongoing drug-resistant tuberculosis (TB) epidemics are characterized by transmission of a limited number of predominant Mycobacterium tuberculosis (Mtb) strains. Understanding how these predominant strains achieve sustained transmission, particularly during the critical period before they are detected via clinical or public health surveillance, can inform strategies for prevention and containment. In this study, we employ whole-genome sequence (WGS) data from TB clinical isolates collected in KwaZulu-Natal, South Africa to examine the pre-detection history of a successful strain of extensively drug-resistant (XDR) TB known as LAM4/KZN, first identified in a widely reported cluster of cases in 2005. We identify marked expansion of this strain concurrent with the onset of the generalized HIV epidemic 12 y prior to 2005, localize its geographic origin to a location in northeastern KwaZulu-Natal ∼400 km away from the site of the 2005 outbreak, and use protein structural modeling to propose a mechanism for how strain-specific rpoB mutations offset fitness costs associated with rifampin resistance in LAM4/KZN. Our findings highlight the importance of HIV coinfection, high preexisting rates of drug-resistant TB, human migration, and pathoadaptive evolution in the emergence and dispersal of this critical public health threat. We propose that integrating whole-genome sequencing into routine public health surveillance can enable the early detection and local containment of AMR pathogens before they achieve widespread dispersal.

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Antimicrobial drug resistance and infection prevention/control: lessons from tuberculosis

International Journal of Infection Control ◽

10.3396/ijic.v17.20840 ◽

2021 ◽

Author(s):

J. Peter Cegielski ◽

Carrie Tudor ◽

Grigory V. Volchenkov ◽

Paul A. Jensen

Keyword(s):

Public Health ◽

Drug Resistance ◽

Infection Prevention ◽

Antimicrobial Drug ◽

Infection Prevention And Control ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Antimicrobial Drug Resistance ◽

The Past ◽

Resistant Tuberculosis

Antimicrobial drug resistance (AMR) is increasing rapidly worldwide, causing an estimated 700,000 deaths annually over the past decade, en route to becoming the leading global threat to public health by 2050 with an estimated 10 million deaths per year (more than heart disease, cancer, and stroke), while reducing global wealth by US$100 trillion. Yet AMR has not received the attention and action required to change this trajectory. Appropriate infection prevention and control (IPC) measures are needed to prevent transmission of infections to healthcare workers (HCWs), other patients, families, and the general public. In this review, we discuss a notable case study of AMR: highly drug-resistant tuberculosis (TB) has emerged repeatedly over the past 70 years as new drugs have been introduced, leading to new diagnostics, therapeutics, funding, public health strategies, and, in high-income countries, effective IPC measures that curtailed transmission. We review current efforts to control and prevent AMR using the example of drug-resistant tuberculosis to highlight important themes including laboratory systems, surveillance, control and prevention of healthcare-associated infections (especially among HCWs), better coordination across disciplines and diseases, and powerful advocacy/social change initiatives grounded in social and behavioral sciences. These strategies are the foundation of an effective response to the AMR threat to public health.

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Neuropsychiatric reactions induced by cycloserine in the treatment of multidrug-resistant tuberculosis: what an Indian female patient tells us

BMJ Case Reports ◽

10.1136/bcr-2019-230993 ◽

2019 ◽

Vol 12 (12) ◽

pp. e230993 ◽

Cited By ~ 2

Author(s):

Enrica Intini ◽

Girija Kishore ◽

Luca Richeldi ◽

Zarir F Udwadia

Keyword(s):

Adverse Events ◽

Multidrug Resistant ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Health Crisis ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Group B

Multidrug-resistant tuberculosis continues to be a public health crisis. Urgent action is required to improve the coverage and quality of diagnosis, treatment and care for people affected by drug-resistant tuberculosis. To implement tuberculosis control, in 2018, WHO recommended cycloserine as one of the Group B drugs. Following this recommendation, cycloserine should be generally included in the starting line-up in the longer regimen for the treatment of multidrug-resistant tuberculosis. However, neurological toxicity associated with this drug concerns clinicians and limits its use. In this paper, we present a case of a 48-year-old woman with a diagnosis of multidrug-resistant tuberculosis treated with cycloserine, who developed psychiatric adverse events after 3 months of administration. This case shows the need for close psychiatric follow-up to promptly detect adverse events in patients receiving regimens for multi-drug resistant tuberculosis.

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