scholarly journals Socio-demographic Profile and Drug Sensitivity Pattern of Suspected Drug Resistant Tuberculosis among Patients in Regional Tuberculosis Reference Laboratory (R.T.R.L) of a Tertiary Hospital

2017 ◽  
Vol 18 (2) ◽  
pp. 62-67 ◽  
Author(s):  
Ummay Fatema Khatun ◽  
Robed Amin ◽  
Muna Islam ◽  
Abdur Rob ◽  
Abdur Rahim
Keyword(s):  
Drug Resistance ◽  
Drug Sensitivity ◽  
Reference Laboratory ◽  
Drug Resistant ◽  
Suspected Drug ◽  
Drug Resistant Tuberculosis ◽  
Demographic Profile ◽  
Resistant Tuberculosis ◽  
Sensitivity Pattern ◽  
Mdr Tb

Background: Drug resistant tuberculosis has been reported in all regions of the world. In this study we address the socio-demographic profile and drug sensitivity pattern as well as prevalence of drug resistance tuberculosis in a tertiary center (regional TB reference laboratory) in Bangladesh.Method: This Study was carried out in R.T.R.L. (Regional TB Reference Laboratory) in 250 bedded Chittagong General Hospital. Patients who were referred to R.T.R.L during the period July 2012 to July 2013 were included in the study. Total 100 patients with suspected drug resistant tuberculosis (TB) who had any one of 9 criteria of NTP (National Tuberculosis Control Programme) were selected consecutively. Gene xpert MTB/RIF (Rifampicin resistance) test for all sputum positive cases were performed. Sputum sample of Patients with positive microscopy for AFB or positive Xpert/MTB was sent for culture. The samples with positive sputum culture were sent for drug sensitivity test for 1st line anti- tubercular drug.Result: Among 100 patients 78 were male and 22 were female, majority of the patients (64) were between 15-45 years with poor socio economic condition (73%) and primarily educated. Analysis of our Study result showed that 18% of patients were mono-drug resistant. Among them 13% showed resistance to isoniazid (INH), 4% to streptomycin and only 2% to rifampicin. No patient was found resistant to pyrazinamide (PNZ) and 38% of patient with suspected drug – resistant TB was found to have no drug resistance. 18% of patient had multidrug resistant tuberculosis (MDR-TB) among which 56% were relapse cases (48% after cat -I, 8% after cat II), 24% were non – converter of cat –I, 12% belonged to failure of cat –I, 3% failure of cat –II, 2% return after default and others. 1% of patient had history of contact with MDR –TB patient.Conclusion: Drug-resistance tuberculosis especially MDR-TB, was higher in patients with previously incomplete anti-tuberculosis treatment. A high level of drug resistance among the re-treatment TB patients poses a threat of transmission of resistant strains to susceptible persons in the community. For this reason proper counseling of patients and attention towards the completion of the anti-TB treatment are needed.J MEDICINE July 2017; 18 (2) : 62-67

scholarly journals Drug resistance profile among multi-drug resistant tuberculosis patients at diagnosis and correlation with history of anti-tubercular treatment in a tertiary care center

2019 ◽  
Vol 6 (6) ◽  
pp. 1918
Author(s):  
Rahul Kumar ◽  
Rajiv Garg ◽  
Silpa Kshetrimayum ◽  
Amita Jain
Keyword(s):  
Drug Resistance ◽  
Drug Sensitivity ◽  
Drug Resistant ◽  
Second Line ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Extensively Drug Resistant ◽  
Primary Drug Resistance ◽  
Mdr Tb ◽  
History Of

Background: Drug Resistant Tuberculosis (DR-TB) is a major threat to the realization of the goal of a TB free world in the near future. It is important to study the reasons for the increasing number of such cases so that effective action can be taken to control this growing epidemic.Methods: Sputum from 36 patients diagnosed with acquired pulmonary Multidrug Resistant Tuberculosis (MDR-TB) were subjected to first- and second-line Drug Sensitivity Testing (DST) after liquid culture in mycobacterium growth Indicator Tube (MGIT). Primary MDR-TB cases were excluded. The relation of the drug sensitivity profile with the history of prior treatment taken was statistically analysed.Results: Majority of the patients had received appropriate treatment, and most had adhered to prescribed treatment. Among the 36 patients, 24(66.7%) were found to be Pre-Extensively Drug Resistant (Pre-XDR-TB) and 4(11.1%) were extensively drug resistant XDR-TB cases. Inappropriate prescription of fluoroquinolone (FQ) was found to be most common. Prior intake of any drug was not found to significantly affect subsequent resistance to that drug.Conclusions: Fluoroquinolone resistance is quite common in patients with DR-TB (66.7%). This study did not find the prior use of FQ or any other drug to significantly affect subsequent resistance to the drug. Primary drug resistance is thus a major concern. 11.1% patients were found to be XDR-TB cases. Hence DST for first- and second-line drugs should be done at the time of diagnosis to avoid failure of treatment with a predesigned regimen.

scholarly journals Mycobaterial interspersed repetitive units-variable number of tandem repeats analysis and pattern of drug resistance in extended drug resistant (XDR) TB isolates from pulmonary tuberculosis patients in Bangladesh

2020 ◽  
Vol 46 (1) ◽  
pp. 22-28
Author(s):  
Shirin Tarafder ◽  
Md Bayzid Bin Monir
Keyword(s):  
Drug Resistance ◽  
Molecular Typing ◽  
Tandem Repeats ◽  
Variable Number ◽  
Drug Resistant ◽  
Gyra Gene ◽  
Drug Resistant Tuberculosis ◽  
Tree Analysis ◽  
Resistant Tuberculosis ◽  
Mdr Tb

Background: To investigate the spread of specific genotypes in a defined geographical area and to determine any relationship of these genotypes with drug resistance the most essential method is molecular typing. It allows a rapid and precise species differentiation. Objective: This study was intended to observe the genotypes of XDR mycobacterium tuberculosis by determining 24 loci MIRU-VNTR analysis. Methods: To gain an insight about molecular typing of MTB and drug resistance-associated mutations in XDR-TB isolates a total of 98 multi drug resistant tuberculosis (MDR-TB) isolates collected through Xpert MTB/RIF assay. They were subjected to 2nd line (Fluoroquinolones, kanamycin, capreomycin and amikacin) drug susceptibility testing through line probe assay (LPA) in a view to detect extensively drug resistant tuberculosis (XDR-TB). Genotyping was done for XDR-TB isolates using 24 loci Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) using the online tool at http://www.MIRU-VNTRplus.org.. Out of 98 MDR-TB isolates 11(11.23%)  XDR-TB isolates were typed and analysed. Results: Twenty four loci MIRU-VNTR genotyping involving similarity searching and phylogenetic tree analysis revealed that six (54.60%) XDR-TB isolates belonged to Beijing strain, Other MTB strain also detected were Delhi/CAS two(18.20%), Haarlem two(18.20%) and New-1, one (9.10%) in number. Minimum spanning tree analysis showed two strain of Beijing family form a clonal complex. Beijing strains were more common among younger age group and within urban population. Beijing strains were also predominant in treatment failure patient. Only one new case of XDR-TB belongs to Delhi/CAS family. Second line mycobacterial drug resistance (MTBDRsl) detected by LPA showed the most prevalent mutations involved in Fluoroquinolones drug resistance (FQ) was Asp94Gly in gyrA gene (54.55%) in quinolone resistance determining region (QRDR) and for Injectable 2nd line Drug resistance (ISL) was A1401G, C1402T in 16S rrs gene (100%)..  All XDR-TB isolates showed resistance to Levofloxacin in 2nd line LPA but Moxifloxacin showed low level resistance to some cases. Conclusion: Molecular typing of XDR- TB isolates and pattern of drug resistance associated mutations in XDR-TB isolates in Bangladesh have not been reported previously. The result of this study highlights the need to reinforce the TB policy in Bangladesh with regard to control the spread and transmission as well as detection and treatment strategies regarding XDR-TB. Bangladesh Med Res Counc Bull 2020; 46(1): 22-28

scholarly journals Evaluation of Nitrate Reductase Assay For Rapid Detection of Drug Resistant Tuberculosis

2019 ◽  
Vol 3 (1) ◽  
pp. 44-46
Author(s):  
Ranjit Kumar Sah ◽  
Dwij Raj Bhatta ◽  
Gokarna Raj Ghimire ◽  
Bhuwaneswor Prasad Kandel ◽  
Bishnu Raj Tiwari ◽  
...  
Keyword(s):  
Nitrate Reductase ◽  
Sensitivity And Specificity ◽  
Susceptibility Testing ◽  
Reference Laboratory ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Nitrate Reductase Assay ◽  
Mdr Tb ◽  
Proportion Method

Emergence of multidrug-resistant tuberculosis (MDR-TB) urgently demands for simple, rapid and inexpensive methods of its detection for the effective treatment of drug resistant tuberculosis, particularly in low-income countries. This prospective study was carried out at National Tuberculosis Reference Laboratory and South Asian Association of Regional Cooperation (SAARC) Tuberculosis and HIV/AIDS Centre, Thimi, Bhaktapur, Nepal, from November 2009 to May 2010 to evaluate nitrate reductase assay (NRA) efficacy for rapid determination of streptomycin, isoniazid, rifampicin and ethambutol susceptibility of Mycobacterium tuberculosis strains. A total of 113 clinical isolates of M. tuberculosis were tested for four first line antitubercular drugs by nitrate reductase assay and were compared with standard proportion method. Results were available in 7-14 days by NRA as compared to proportion method which generally takes 4-6 weeks. The sensitivity and specificity of NRA were 98.1% and 100% for isoniazid, 95.1% and 98.6% for rifampicin, 91.4% and 94.9% for streptomycin, and 78.6% and 97.9% for ethambutol respectively. Agreement between NRA and proportion method were 99.1%, 97.3%, 93.8%, 95.6% for isoniazid, rifampicin, streptomycin and ethambutol, respectively. NRA is easier, inexpensive and reliable method for susceptibility testing of Mycobacterum tuberculosis for isoniazid and rifampicin, the two most important drugs for the treatment of tuberculosis. The reduction in susceptibility testing time, and higher sensitivity and specificity of NRA method is of fundamental importance in detecting MDR-TB. Key words: Drug susceptibility, MDR-TB, NRA, proportion method

scholarly journals 770. Multi-Drug-Resistant Tuberculosis Cases in Arkansas in 2017: A Tale of Two Threats

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S276-S276
Author(s):  
Emily Weldon ◽  
Naveen Patil ◽  
Jan Voyles ◽  
Sandra Chai ◽  
Marsha Majors ◽  
...  
Keyword(s):  
Drug Resistance ◽  
The United States ◽  
The Philippines ◽  
Drug Susceptibility Testing ◽  
Marshall Islands ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb

Abstract Background Multi-drug-resistant tuberculosis (MDR-TB) is a threat to TB elimination strategies worldwide. From 1998 to 2016, six cases of MDR-TB were reported in Arkansas. In 2017 alone, three cases were detected. We sought to describe the characteristics of these cases to inform our MDR-TB prevention strategy in AR. Methods The surveillance database identified three MDR-TB cases in 2017. A detailed review was done to define the demographics, clinical presentation, and laboratory reports relating to drug susceptibility testing (DST), including molecular detection of drug resistance (MDDR). A search was done in the Genotyping database for genotype patterns of the patient isolates. Results All three cases were born outside the United States and developed active disease after arrival in AR. Case 1, age 52, was born in the Marshall Islands, arrived in 2016, and had a history of Type 2 diabetes. He developed MDR-TB in February 2017. Case 2, age 42, was born in Mexico, arrived over 20 years ago, and was HIV positive. He developed TB in July 2016 with a pan-sensitive organism and completed an intermittent treatment regimen. A second TB episode with matching genotype but different drug sensitivities occurred in April 2017, less than 4 months after treatment completion, and was considered treatment failure. Case 3, age 56, was born in the Philippines, arrived in 1990, and was reportedly treated for latent TB infection in 1993 with 6 months of isoniazid. She visited the Philippines April–May 2017 and developed MDR-TB in October 2017. Her isolate was in cluster with a case in Oklahoma who came from Mexico in 2006 and was admitted in an AR hospital with a pan-sensitive organism. There are no epidemiological links between the two cases; only one isolate in each case. Because both isolates were identified in AR State TB laboratory, a complex contamination has been considered with no definite resolution at this time. Conclusion MDR-TB, due to both primary and secondary drug resistance, remains a threat in AR. Cooperation and communication between all levels of healthcare are crucial to avoid delayed diagnosis of MDR-TB. Timely DST via technologies like GeneXpert and MDDR service at CDC is critical. Consultation from Centers of Excellence is vital in the treatment of MDR-TB complicated by diabetes and HIV. Whole-genome sequencing could provide clarity in the cluster with discordant DST patterns. Disclosures All authors: No reported disclosures.

scholarly journals Issues of Tuberculosis Drug-Resistance in Kharkiv Region and in Ukraine

2019 ◽  
pp. 24-28
Author(s):  
O.S. Shevchenko ◽  
O.O. Pohorielova
Keyword(s):  
Drug Resistance ◽  
Statistical Processing ◽  
Multidrug Resistant ◽  
Study Data ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Extensively Drug Resistant ◽  
Mdr Tb ◽  
Microsoft Office

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.

scholarly journals ADENOSINE DEAMINASE LEVEL IN DRUG RESISTANT TUBERCULOSIS

2021 ◽  
Vol 9 (09) ◽  
pp. 179-187
Author(s):  
Adewole Pelumi Daniel ◽  
◽  
Owolabi Folayemi Veronica ◽  
Adelakun Adedayo Olabode ◽  
◽  
...  
Keyword(s):  
Drug Resistance ◽  
Blood Sample ◽  
Adenosine Deaminase ◽  
Healthy Controls ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Adenosine Deaminase Activity ◽  
Mdr Tb ◽  
Study Participants

Tuberculosis (TB) remains one of the health problems in Nigeria and worldwide. Adenosine Deaminase acts in proliferation and differentiation of lymphocyte, especially T lymphocyte. It also acts in maturation of monocytes transforming them to macrophage. Adenosine Deaminase is a significant indicator of active cellular immunity. Adenosine Deaminase has been proposed to be a useful surrogate marker for TB because it can be detected in body fluids such as pleural, pericardial and peritoneal fluid. This study aimed to determine the relationship between Adenosine Deaminase and drug Resistant Tuberculosis (DR-TB) among patients attending Tuberculosis Clinic in Government Chest Hospital, Jericho, Oyo State, Nigeria. Methodology: A prospective case-control study involving thirty (30) Multi-Drug Resistance Tuberculosis patients and thirty (30) apparently healthy participants in Tuberculosis Clinic in Government Chest Clinic Hospital, Jericho, Oyo State, Nigeria. Theparticipants socio-demographic data was obtained using questionnaire. Sputum samples were collected from each patient from the two groups of participants in leak proof screw capped specimen containers. About 5 mL of venous blood sample was collected from the antecubital fossa of the study participants into vacutainer plain tubes. Sputum samples collected were analysed for Mycobacterium tuberculosis using Gene Xpert. Blood sample collected was analyzed for Adenosine Deaminase using ELISA method. The prevalence of MDR-TB was 0.18%, majority of MDR-TB were within age of 15-30 years with mean age 36.30±13.40 years with female having 63.3% and male 36.7%. Among MDR-TB, the mean±SD Adenosine Deaminase activity was 37.67±15.25 IU/L and among Healthy controls, the mean±SD of Adenosine Deaminase was 12.26±5.11 IU/L. There was significance increased in ADA activity among MDR-TB participants when compared to Healthy controls at p-value<0.05 (p=0.001). ADA level of 18 IU/L cut off point has a sensitivity of 90.0%, specificity of 87.0% and diagnostic accuracy of 88.0%. In conclusion, there was moderately high prevalence of MDR-TB among the study participants. There was increased in ADA levels among MDR-TB. High sensitivity and specificity of ADA activity was observed among MDR-TB. This might be a useful alternative test to diagnose and rule out drug resistance tuberculosis.

scholarly journals Drug-resistant Tuberculosis: First Line Drug Resistance Pattern among Mycobacterium Tuberculosis Strains Isolated from a Reference Laboratory in Kerala State, India

2021 ◽  
Author(s):  
Neetha S Murthy ◽  
Sanjeev Nair ◽  
PK Ramya ◽  
Renu Susan George ◽  
B Ravikrishnan ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Resistance Mutation ◽  
Resistance Pattern ◽  
Reference Laboratory ◽  
Drug Resistant ◽  
Isoniazid Resistance ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Drug Resistance Pattern ◽  
S531l Mutation

Resistance to antimycobacterial agents consistently remains a major obstacle to end TB in India. Geographical prevalence data regarding drug-resistant evolutionary genetics of M. tuberculosis (MTB) remains sparse in India. Our objective was to determine the genotypic drug resistance mutation pattern for Rifampicin and Isoniazid of MTB isolates to gain an understanding of the prevailing molecular epidemiology of drug-resistant tuberculosis. In this study 2528 M. tuberculosis DNA isolates from presumptive DRTB suspects received at the nodal TB reference laboratory in Kerala were tested for Rifampicin and Isoniazid resistance by sequence-based diagnostic Line Probe assay (LPA). Geographical prevalence and associations of rpoB, katG, inhA resistance codons was analyzed from January 2019 to March 2020. Among the 2528 DNA samples subjected for Rifampicin and Isoniazid resistance determination by LPA, 146 (5.8%) isolates were resistant to both drugs. Isoniazid mono-resistance was found in 164 (6.5%) and Rifampicin mono-resistance in 38 (1.5%) isolates. The most frequent rpoB mutation was S531L (60.32%) followed by S531W/L533P mutations seen in 8.15% of the isolates. S315T1 KatG mutation was seen in 97.33% of Isoniazid resistant isolates. 84.68% isolates with rpoB S531L mutation were found to be multidrug-resistant. 82.9% of isolates with rpoB S531L mutation showed katG S315T1 mutation. Mono isoniazid-resistant isolates were significantly higher compared to mono rifampicin-resistant isolates among the DNA isolates studied in our region. The molecular epidemiological pattern most frequently associated with multidrug resistance was rpoB S531L which was significantly associated with the co-presence of S315T1 mutation.

scholarly journals Risk Factors and Treatment Outcome Analysis Associated with Second-Line Drug-Resistant Tuberculosis

2021 ◽  
Vol 2 (1) ◽  
pp. 1-12
Author(s):  
Muralidhar Aaina ◽  
Kaliyaperumal Venkatesh ◽  
Brammacharry Usharani ◽  
Muthukumar Anbazhagi ◽  
Gerard Rakesh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Drug Resistance ◽  
Drug Resistant ◽  
First Line ◽  
Drug Resistant Tuberculosis ◽  
Factors Associated ◽  
Resistant Tuberculosis ◽  
Increased Risk ◽  
Mdr Tb ◽  
Line Drug

The present study aimed at analyzing the treatment outcomes and risk factors associated with fluoroquinolone drug resistance having mutations in the gyrA and gyrB genes. A total of 258 pulmonary tuberculosis samples with first-line drug-resistant (H, R, or HR) were subjected to GenoType MTBDRsl assay for the molecular detection of mutations. Among the 258 samples, 251 were drug-resistant tuberculosis and seven were sensitive to all first-line TB drugs. Out of 251 DR-TB cases, 42 cases were MDR TB, 200 were INH mono-resistant and nine cases were RIF mono-resistant tuberculosis. Out of 251 DR-TB cases performed with a MTBDRsl assay, 14 had Pre-XDR-FQ, one patient had pre-XDR-SLID, one had extensively drug-resistant tuberculosis (XDR-TB) and 235 cases were sensitive to both FQ and SLID drugs. The study group had a mean average of 42.7 ± 16.4 years. The overall successful treatment outcomes among the MDR, INH mono-resistant, and pre-XRD patients were 70.6%, 82.0%, and 51%, respectively. The percentage of risk for the unfavorable outcomes in the pre-XDR, INH -mono-resistant, and XDR cases were 113.84% increased risk with RR 2.14; 95% CI 0.7821–5.8468. The independent risk factor associated with the unfavorable outcomes to failure was 77.78% increased risk with RR 1.78; 95% CI 0.3375–9.3655. Logistic regression analysis revealed that the percentage relative risk among MDR-TB patients for gender, male (RR: 1.85), age ≥ 61 years (RR: 1.96), and diabetics (RR: 1.05) were 84.62%, 95.83%, and 4.76%, respectively. The independent risk factors associated with INH mono-resistant cases of age 16–60 (RR: 1.86), ≥61 year (RR: 1.18), and treated cases (RR: 5.06). This study presaged the significant risk of INH mono-resistant, pre-XDR, and MDR among males, young adults, diabetics, and patients with previous treatment failure. Timely identification of high-risk patients will give pronounced advantages to control drug resistance tuberculosis diseases.

scholarly journals A study on multi drug resistant tuberculosis at Sree Mookambika Institute of Medical Sciences

2017 ◽  
Vol 4 (9) ◽  
pp. 3234
Author(s):  
Prashant V. Solanke ◽  
Preeti Pawde ◽  
Ajin R. M.
Keyword(s):  
Drug Resistance ◽  
Mycobacterium Tuberculosis ◽  
Sputum Culture ◽  
Multi Drug Resistance ◽  
Drug Resistant ◽  
Medical Sciences ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb

Background: Tuberculosis (TB) is one of the major causes of morbidity and mortality worldwide. Resistance to antitubercular drugs has been noted since the drugs were first introduced, and occasionally outbreaks of drug-resistant tuberculosis have been reported worldwide. WHO emphasizes that good TB control prevents the emergence of drug resistance in the first place and that the proper treatment of multi-drug resistant tuberculosis prevents the emergence of XDR-TB. The objectives of the study were to examine the sputum samples regarding MDR-TB, to study the grading regarding sputum positive and to study the multi-drug resistance tuberculosis in Sree Mookambika Institute of Medical sciences.Methods: Study design was cross-sectional, Study duration was January 2016-March 2017. Study place was Sree Mookambika Institute of Medical Sciences Hospital, Kulasekharam. Sample size was 400. Data entered in MS-Office Word- 2016. Institutional ethical committee clearance was obtained. Results: In present study 54.86% patient had sputum AFB positive, 45.13% had sputum AFB negative smears. 75% of the sputum AFB positive pulmonary TB came under the age group between 20-60 and 25% above 60 yrs. 78.24% males, 21.75% females had sputum AFB smear positive pulmonary tuberculosis and 43.73% patients had positive sputum culture, 56.26% patients had negative sputum culture and the most common strain found was Mycobacterium tuberculosis. Conclusions: So from our study we found that Mycobacterium tuberculosis is the major strain isolated from sputum samples. The resistance is more to Isoniazid and Rifampicin and is more in the rural parts of India. Early screening and drug susceptibility test of culture positive and MTB cases will help in initiating treatment of MDR-TB. 

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