Evaluation of the microscopic observational drug susceptibility assay for rapid and efficient diagnosis of multi-drug resistant tuberculosis

Introduction: Rapid genotypic and phenotypic methods for multi-drug-resistant-tuberculosis (MDR-TB) detection are now widely available. Zimbabwe adopted the use of GeneXpert-MTB/RIF, microscopic-observation-drug-susceptibility-assay (MODS) and Mycobacteria-Growth-Indicator-Tube (MGIT) drug-susceptibility-testing (DST). Data is limited on the ideal combination of use of these methods in resource limited settings. Methodology: Between August 2014 to July 2015, 211 sputa from MDR-TB suspects were tested with GeneXpert-MTB/RIF, MODS, manual-MGIT and Lowenstein-Jensen (LJ)-DST to determine diagnostic accuracy and turnaround-time (TAT), with LJ-DST as the gold standard. A performance score ranking table for diagnostic accuracy, TAT, costs, facilities and expertise requirements, was used to determine the most favourable tool. Results: GeneXpert-MTB/RIF sensitivity was 96% (95%CI:80-100) and specificity was 95% (95%CI:90-97). MODS sensitivity was 88% (95%CI:68-97) and specificity was 97% (95%CI:87-100). Manual MGIT-DST had slightly lower sensitivity of 80% (95%CI:59-93). Median time to detection of MDR-TB was <1 day (IQR:0-0) for Xpert, 14 days (IQR:11-31) for MODS, 21 days (IQR:7-22) for MGIT-DST and 28 days (IQR:25-28) for LJ-DST. Operational costs for MODS, MGIT-DST, and GeneXpert-MTB/RIF were $21.20, $27.52 and $39.76 respectively. From a summation of scores including facility and expertise requirements per diagnostic technique, GeneXpert-MTB/RIF was the most favourable tool, followed by MODS and MGIT-DST. Conclusions: For best scale-up of MDR-TB diagnosis in Zimbabwe, GeneXpert-MTB/RIF can be used for rapid detection of TB in smear negative cases, RIF-susceptibility for early treatment initiation and probable MDR-TB. MODS can rapidly confirm probable MDR-TB detected by GeneXpert-MTB/RIF, manual-MGIT can provide early results for susceptibility to other antibiotics, with affordable costs, with LJ-DST confirming discordant DSTs.

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A Study on the Drug Susceptibility Test of Multi-Drug Resistant Tuberculosis Patients.

Korean Journal of Epidemiology ◽

10.4178/kje.2008.30.2.301 ◽

2008 ◽

Vol 30 (2) ◽

pp. 301-308 ◽

Cited By ~ 2

Author(s):

Mun Deok Han ◽

Jeong Soo Im ◽

Jun Yim ◽

Dae Kyu Oh

Keyword(s):

Drug Susceptibility ◽

Susceptibility Test ◽

Drug Resistant ◽

Drug Susceptibility Test ◽

Drug Resistant Tuberculosis ◽

Tuberculosis Patients ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis

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Second Line Drugs Resistant Mycobacterium Tuberculosis in Multi-Drug Resistant Tuberculosis Patients

Journal of Institute of Science and Technology ◽

10.3126/jist.v22i2.19609 ◽

2018 ◽

Vol 22 (2) ◽

pp. 168-174

Author(s):

Pranita Tuladhar ◽

Dhruba Kumar Khadka ◽

Megha Raj Banjara ◽

Reshma Tuladhar

Keyword(s):

Drug Susceptibility ◽

Resistance Pattern ◽

Drug Resistant ◽

Second Line ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Mdr Tb ◽

Culture Positive ◽

Line Drug

With an increase in Multi-drug resistant tuberculosis (MDR-TB), there is a need of second line drug susceptibility test that helps in early diagnosis and minimize the risk of other powerful drug resistant Mycobacterium tuberculosis. The aim of this study was to determine second line drugs (ofloxacin, kanamycin, capreomycin) resistance pattern in MDR-TB isolates and to determine the prevalence of pre-Extensively drug resistant tuberculosis (pre-XDR-TB) and XDR-TB in MDR-TB patients. The study was conducted from February to September 2015 at National Tuberculosis Centre, Thimi, Bhaktapur. MDR-TB (resistant to isoniazid and rifampicin) patients’ sputum samples were processed by Modified Petroff’s method. Out of 92 samples, 57 were found culture positive. Following the species identification of culture positive MDR-TB isolates, second line drug susceptibility test was performed by conventional proportion method. Of 57 MDR-TB isolates, 22 (38.59%) showed resistance to ofloxacin (Ofx), 9 (15.79%) to capreomycin (Cm) and 9 (15.79%) to kanamycin (Km). One XDR-TB (1.8%) resistant to all drugs was detected. Of the remaining, 21(36.8%) were resistant to ofloxacin only and 8(15.4%) were resistant to two drugs i.e.29 (50.9%) were pre-XDR-TB. The prevalence of pre-XDR-TB and XDR-TB was found to be 50.88% and 1.75% respectively. The resistance pattern of second line anti-tuberculosis drugs showed higher ofloxacin resistance in MDR-TB patients. In a nutshell, MDR-TB cases need urgent and timely susceptibility report for second line anti-tuberculosis drugs to help the clinicians start proper drug combinations to treat MDR-TB patients. Journal of Institute of Science and Technology Volume 22, Issue 2, January 2018, page: 168-174

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Drug Resistant Tuberculosis in the Northern Region of Zambia: A Retrospective Study

Frontiers in Tropical Diseases ◽

10.3389/fitd.2021.735028 ◽

2021 ◽

Vol 2 ◽

Author(s):

Ngula Monde ◽

Mildred Zulu ◽

Mathias Tembo ◽

Ray Handema ◽

Musso Munyeme ◽

...

Keyword(s):

Drug Resistance ◽

Susceptibility Testing ◽

Drug Susceptibility ◽

Drug Susceptibility Testing ◽

Multi Drug Resistance ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Tuberculosis Patients ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis

BackgroundZambia like many countries in sub-Saharan Africa is affected with drug resistant tuberculosis. However, the drug resistant tuberculosis situation over the years has not been described in various regions of the country. Consequently, this study aims to determine the drug resistant tuberculosis burden in northern regions of Zambia over a four-year period based on data generated from a Regional Tuberculosis Reference Laboratory.MethodTwo hundred and thirty two (232) Tuberculosis Drug Susceptibility Testing results over a four-year period (2016-2019) were reviewed. Data was collected from tuberculosis registers and patient request forms and entered into a pre-tested standardized checklist and later entered in Excel Computer software. Double blinded checking was done by two independent data clerks to minimize duplication of cases. Cleaned data was then imported in R programme for analysis. Bivariant and descriptive statistics were performed and reported.ResultsOf 232 Drug Susceptibility Testing results, 90.9% were drug resistant TB while 9% were drug susceptible. Fifty three percent (53%) of these were multi-drug resistant Tuberculosis and 32% were confirmed as Rifampicin Mono-resistance. Only 1.7% of the Multi-drug resistant Tuberculosis patients were Pre-extensively drug-resistant Tuberculosis. Copperbelt province had the largest proportion (46.0%) of multi-drug resistant tuberculosis patients followed by Luapula (8.1%) and North-Western (4.7%) provinces. In new and previously treated patients, the proportion of Multi-drug resistant tuberculosis was 71.8% and 28.7% respectively. History of previous anti-tuberculosis treatment and treatment failure were associated with multi-drug resistance TB.Conclusion and RecommendationThis study has shown a small increase in the proportions of drug resistant tuberculosis cases over the four years under review with high rates being recorded on the Copperbelt Province. Previous treatment to first line TB treatment and treatment failure were associated with development of Multi-drug resistance. We therefore recommend strengthened routine laboratory surveillance and improved case management of multi-drug resistant tuberculosis patients in the region.

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Microscopic-Observation Drug-Susceptibility Assay for the Diagnosis of Drug-Resistant Tuberculosis in Harare, Zimbabwe

PLoS ONE ◽

10.1371/journal.pone.0055872 ◽

2013 ◽

Vol 8 (2) ◽

pp. e55872 ◽

Cited By ~ 17

Author(s):

Beauty Makamure ◽

Jesca Mhaka ◽

Salome Makumbirofa ◽

Reggie Mutetwa ◽

Lucy Mupfumi ◽

...

Keyword(s):

Microscopic Observation ◽

Drug Susceptibility ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Susceptibility Assay

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Abstract #1036 Hypothyroidism Induced by Multi Drug Resistant Tuberculosis (MDR-TB) Treatment

Endocrine Practice ◽

10.1016/s1530-891x(20)47401-4 ◽

2018 ◽

Vol 24 ◽

pp. 236

Author(s):

Rulli Rosandi

Keyword(s):

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Mdr Tb

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Exploring patient-provider factors for risk of developing Multi-drug Resistance Tuberculosis in Southern Ethiopia: Qualitative Operation Research (Preprint)

10.2196/preprints.13366 ◽

2019 ◽

Author(s):

Yitagesu Habtu ◽

Tesema Bereku ◽

Girma Alemu ◽

Ermias Abera

Keyword(s):

Phenomenological Study ◽

Treatment Success ◽

World Health ◽

Multi Drug Resistance ◽

Southern Ethiopia ◽

Drug Resistant ◽

Related Factors ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis

BACKGROUND Ethiopia is one of among thirty high burden countries of multi-drug resistant tuberculosis (MDR-TB) in the regions of world health organization. Contextual evidence on the emergence of the disease is limited at a program level. OBJECTIVE The aim of the study is to explore patient-provider factors that may facilitate the emergence of multi-drug resistant tuberculosis. METHODS We used a phenomenological study design of qualitative approach from June to July, 2015. We conducted ten in-depth interviews and 4 focus group discussions with purposely selected patients and providers. We designed and used an interview guide to collect data. Verbatim transcribes were exported to open code 3.4 for emerging thematic analysis. Domain summaries were used to support core interpretation. RESULTS The study explored patient-provider factors facilitating the emergence of multi-drug resistant tuberculosis. These factors as underlying, health system and patient-related factors. Especially, the a shows conflicting finding between having a history of discontinuing drug-susceptible tuberculosis and emergence of multi-drug resistant tuberculosis. CONCLUSIONS The patient-provider factors may result in poor early case identification, adherence to and treatment success in drug sensitive or multi-drug resistant tuberculosis. Our study implies the need for awareness creation about multi-drug resistant tuberculosis for patients and further familiarization for providers. This study also shows that patients developed multi-drug resistant tuberculosis though they had never discontinued their drug-susceptible tuberculosis treatment. Therefore, further studies may require for this discording finding.

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