Pattern of Anti-Tuberculosis Drug Resistance in HIV-Associated Tuberculous Meningitis Patients

2019 ◽  
Vol 31 (1) ◽  
pp. 52-58
Keyword(s):  
Drug Resistance ◽  
Tuberculous Meningitis ◽  
Susceptibility Testing ◽  
Public Health Problem ◽  
Drug Susceptibility ◽  
Drug Susceptibility Testing ◽  
Major Public Health Problem ◽  
First Line ◽  
Cross Sectional ◽  
Cd4 Cell Count

Multidrug-resistant tuberculosis (MDR-TB) is a major public health problem worldwide. Human immunodeficiency virus (HIV) infection-associated tuberculous meningitis (TBM) further complicates the patient management and causes poor prognosis. A cross-sectional study was carried out to determine anti-TB drug susceptibility pattern of Mycobacterium tuberculosis (MTB) isolates from HIV-associated TBM patients at Waibagi, Thakayta and Mingaladon Specialist Hospitals in Yangon, Myanmar. From January to October 2017, cerebrospinal fluid (CSF) specimens collected from 140 HIV infected patients with clinically presumptive TBM were applied for isolation and drug susceptibility testing. First-line drug susceptibility testing were carried out by solid culture-based proportion method. Drug susceptibility patterns of pyrazinamide, fluoroquinolones and second-line injectable drugs were determined by liquid culture-based Mycobacterial Growth Indicator Tube method. There were 17 culture positives and confirmed as MTB out of 140 specimens. Among them,10 isolates (58.8%) were resistant to at least one of the first-line anti-TB drugs. Eight isolates (47.1%) showed multidrug resistance but there was no extensively drug resistance. HIV-associated TBM patients with previous anti-TB treatment history and CD4 cell count of less than 100 cells/μl were significantly more prone to develop drug resistance. These findings highlight burdens of anti-TB drug resistance among HIVassociated TBM patients and support the need of elaborative management strategies.

scholarly journals Molecular Detection of Mutations Associated with First- and Second-Line Drug Resistance Compared with Conventional Drug Susceptibility Testing of Mycobacterium tuberculosis

2011 ◽  
Vol 55 (5) ◽  
pp. 2032-2041 ◽  
Author(s):  
Patricia J. Campbell ◽  
Glenn P. Morlock ◽  
R. David Sikes ◽  
Tracy L. Dalton ◽  
Beverly Metchock ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Mycobacterium Tuberculosis ◽  
Dna Sequencing ◽  
Susceptibility Testing ◽  
Drug Susceptibility ◽  
Drug Susceptibility Testing ◽  
Second Line ◽  
First Line ◽  
Content Type ◽  
Line Drug

ABSTRACTThe emergence of multi- and extensively drug-resistant tuberculosis is a significant impediment to the control of this disease because treatment becomes more complex and costly. Reliable and timely drug susceptibility testing is critical to ensure that patients receive effective treatment and become noninfectious. Molecular methods can provide accurate and rapid drug susceptibility results. We used DNA sequencing to detect resistance to the first-line antituberculosis drugs isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB) and the second-line drugs amikacin (AMK), capreomycin (CAP), kanamycin (KAN), ciprofloxacin (CIP), and ofloxacin (OFX). Nine loci were sequenced:rpoB(for resistance to RIF),katGandinhA(INH),pncA(PZA),embB(EMB),gyrA(CIP and OFX), andrrs,eis, andtlyA(KAN, AMK, and CAP). A total of 314 clinicalMycobacterium tuberculosiscomplex isolates representing a variety of antibiotic resistance patterns, genotypes, and geographical origins were analyzed. The molecular data were compared to the phenotypic data and the accuracy values were calculated. Sensitivity and specificity values for the first-line drug loci were 97.1% and 93.6% forrpoB, 85.4% and 100% forkatG, 16.5% and 100% forinhA, 90.6% and 100% forkatGandinhAtogether, 84.6% and 85.8% forpncA, and 78.6% and 93.1% forembB. The values for the second-line drugs were also calculated. The size and scope of this study, in numbers of loci and isolates examined, and the phenotypic diversity of those isolates support the use of DNA sequencing to detect drug resistance in theM. tuberculosiscomplex. Further, the results can be used to design diagnostic tests utilizing other mutation detection technologies.

scholarly journals First line anti-tubercular drug resistance among patients visiting German Nepal Tuberculosis Project, Nepal

2013 ◽  
Vol 2 (2) ◽  
pp. 45-48
Author(s):  
S Regmi ◽  
B Shrestha ◽  
A Katuwal
Keyword(s):  
Drug Resistance ◽  
Public Health Problem ◽  
Drug Susceptibility ◽  
Multidrug Resistant ◽  
Sputum Smear ◽  
Major Public Health Problem ◽  
Drug Resistant ◽  
First Line ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis

INTRODUCTION: Tuberculosis is one of the commonest causes of death in the world. It remains a major public health problem in developing countries including Nepal. Despite the reduction in incidence of tuberculosis by the implementation of anti-tuberculosis drugs regimen, TB remains pandemic due to emergence of drug resistant strain of M. tuberculosis. The aim of this study was to evaluate the first line anti-tubercular drug resistance among patients visiting German Nepal Tuberculosis Project, Nepal. MATERIALS AND METHODS: Anti-tubercular drug susceptibility test for first line drugs (Rifampicin, Isonizid, Ethambutol, and Streptomycin) was performed by proportion method (n=141) for new sputum smear positive patients attending German Nepal Tuberculosis Project, Kathmandu, Nepal. RESULTS: 78.1% (n=110.) were sensitive to all 4 drugs. Eight isolates (5.6%), 4(2.8%), 10(7.1%) and 31(21.9%) were resistant to any 4, 3, 2 and 1 drug respectively. Proportion of drug resistant (PDR) to one drug was 12.6%, two drugs 7.6%, three drugs (6.3%) and four drugs was 5.6%. Our result indicates the PDR to the first line drug was 21.9% and multidrug resistant (MDR) was 12 (8.5%). CONCLUSIONS: Drugs resistant cases of tuberculosis in increasing. Surveillance and monitoring of the drug resistant tuberculosis is necessary to prevent emergence of MDR, extensively drug resistant and so-called totally drug resistant tuberculosis.  DOI: http://dx.doi.org/10.3126/ijim.v2i2.8321   Int J Infect Microbiol 2013;2(2):45-48

scholarly journals Comparison of the Performances of Two In-House Rapid Methods for Antitubercular Drug Susceptibility Testing

2008 ◽  
Vol 53 (2) ◽  
pp. 808-810 ◽  
Author(s):  
Agustina I. de la Iglesia ◽  
Emma J. Stella ◽  
Héctor R. Morbidoni
Keyword(s):  
Drug Resistance ◽  
Mycobacterium Tuberculosis ◽  
Sensitivity And Specificity ◽  
Susceptibility Testing ◽  
Drug Susceptibility ◽  
Drug Susceptibility Testing ◽  
Antitubercular Drug ◽  
Rapid Methods ◽  
Resistance Assessment

ABSTRACT Resistance to rifampin (rifampicin), isoniazid, and streptomycin of 69 Mycobacterium tuberculosis isolates was analyzed by an in-house method based on mycobacteriophage D29 and a colorimetric micromethod. Both methods showed sensitivity and specificity values ranging from 93% to 100%. These simple methods offer an option for drug resistance assessment of M. tuberculosis.

scholarly journals Clinical evaluation of the Xpert MTB/XDR assay for rapid detection of isoniazid, fluoroquinolone, ethionamide and second-line drug resistance: A cross-sectional multicentre diagnostic accuracy study

2021 ◽  
Author(s):  
Adam Penn-Nicholson ◽  
Sophia B Georghiou ◽  
Nelly Ciobanu ◽  
Mubin Kazi ◽  
Manpreet Bhalla ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Diagnostic Accuracy ◽  
Susceptibility Testing ◽  
Drug Susceptibility ◽  
Drug Susceptibility Testing ◽  
Foreign Affairs ◽  
Second Line ◽  
Reference Standard ◽  
Composite Reference Standard ◽  
Resistance Detection

Background The WHO End TB Strategy requires universal drug susceptibility testing and treatment of all people with tuberculosis. However, available second-line diagnostic tools are cumbersome and require sophisticated laboratory infrastructure, and ultimately less than half of those with drug-resistant tuberculosis receive appropriate treatment. Xpert MTB/XDR was developed to help overcome these limitations. Methods We assessed the diagnostic accuracy of sputum-based Xpert MTB/XDR for isoniazid, fluoroquinolone, ethionamide and second-line injectable resistance detection in adults with an Xpert MTB/RIF or Ultra Mycobacterium tuberculosis-positive result against a composite reference standard of phenotypic drug-susceptibility testing and whole genome sequencing (NCT03728725). Participants with pulmonary tuberculosis symptoms and ≥1 risk factor for drug resistance were consecutively enrolled between four clinical sites in India, Moldova and South Africa. Findings Between 31 July 2019 and 21 March 2020, we enrolled 710 patients, of which 611 (86.1%) had results from index and composite reference standard tests and were included in analysis. The sensitivity of Xpert MTB/XDR was 94% for isoniazid, 95% for fluoroquinolones, 54% for ethionamide, 73% for amikacin, 86% for kanamycin, and 61% for capreomycin resistance detection. Specificity was 98-100% for all drugs. Performance was equivalent to line-probe assays. The non-determinate rate of Xpert MTB/XDR was 2.96%. Interpretation This first prospective, multicentre clinical study of the Xpert MTB/XDR assay demonstrated high diagnostic test accuracy, meeting target product profile criteria for a next-generation drug susceptibility test. Funding German Federal Ministry of Education and Research through KfW, Dutch Ministry of Foreign Affairs, and Australian Department of Foreign Affairs and Trade.

scholarly journals Drug resistance mechanisms and drug susceptibility testing for tuberculosis

Respirology ◽  
2018 ◽  
Vol 23 (12) ◽  
pp. 1098-1113 ◽  
Author(s):  
Paolo Miotto ◽  
Ying Zhang ◽  
Daniela Maria Cirillo ◽  
Wing Cheong Yam
Keyword(s):  
Drug Resistance ◽  
Susceptibility Testing ◽  
Drug Susceptibility ◽  
Resistance Mechanisms ◽  
Drug Susceptibility Testing

Tuberculous Meningitis During Chemotherapy for Pulmonary Tuberculosis

PEDIATRICS ◽  
1970 ◽  
Vol 45 (4) ◽  
pp. 714-715
Author(s):  
Morris Steiner ◽  
Phillip Steiner
Keyword(s):  
Pulmonary Tuberculosis ◽  
Tuberculous Meningitis ◽  
Susceptibility Testing ◽  
Drug Susceptibility ◽  
Drug Susceptibility Testing ◽  
Spinal Fluid ◽  
Active Pulmonary Tuberculosis

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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