Extrapulmonary drug-resistant tuberculosis (DR-EPTB) poses a formidable diagnostic and therapeutic challenge.Besides associated with high morbidity, it is a major financial burden for the patient and the health system. In spite of this, it has often been neglected as it does not “pose” a visible public health threat. We study clinical profiles, treatment outcomes, and factors associated with unfavourable outcomes among DR-EPTB patients under programmatic settings in New Delhi, India, and evaluate how this could impact TB elimination. A retrospective analysis of all DR-EPTB patients registered at three nodal DR-TB centres in Delhi in 2016 was carried out. Of the 1261 DR-TB patients registered, 203 (16%) were DR-EPTB, with lymph nodes (118, 58%) being the most common site, followed by bone (69, 34%). Nearly 29% (n = 58) experienced adverse drug reactions with severe vomiting (26, 13 %), joint pain (21, 10%) and behavioral disorder (15, 7%). History of previous TB treatment was observed in a majority of the cases (87.7%). Nearly one-third of DR-EPTB cases (33%) had unfavourable treatment outcomes, with loss-to-follow-up (n = 40, 58%) or death (n = 14, 20%) being the most common unfavourable outcomes. In the adjusted analysis, weight band 31–50 kilograms (aRR = 1.8, 1.2–3.4) and h/o previous TB (aRR = 2.1, 1.1–4.8) were mainly associated with unfavourable outcomes. TB elimination efforts need to focus on all forms of TB, including DR-EPTB, leaving no one behind, in order to realise the dream of ending TB.

Crystalline basement rock aquifers underlie more than 20% of the earth’s surface. However, owing to an inadequate understanding of geological structures, it is challenging to locate the groundwater resources in crystalline hard rock terranes. In these terranes, faults, fractures, and shear zones play an important role in bedrock weathering and ultimately groundwater storage. This study integrates important geological structures with 2D high-resolution subsurface resistivity images in understanding the factors that influenced bedrock weathering and groundwater. The results reveal the variability of weathered zone depth in different structural zones (Zone-I to Zone-IV). This is due to the presence of foliations, fractures, and faults. A thicker weathered zone develops when a fracture/fault overprints a pre-existing planar pervasive structure like foliations (Zone-II) as compared to zones only with faults/fractures (Zone-III). Further, the transmissivity of boreholes also shows relatively higher in Zone-II than Zone-III, which implies a good pact between different structural features and possible groundwater storage. The study also demonstrates the role of paleostress and different tectonic structures influencing the depth of the “Critical Zone”. While the geology may vary for different structural terranes, the approach presented in this paper can be readily adopted in mapping bedrock weathering and groundwater resources in crystalline basement terranes globally.

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