BACKGROUNDSputum smear negative pulmonary tuberculosis remains a significant burden with a definite role in disease transmission too. They sometimes pose a diagnostic challenge to the treating physician. CBNAAT, a newly endorsed WHO technique, which not only detects the tubercle bacilli but also tells about the resistance to rifampicin, may have a role in sputum smear negative patients if bronchoalveolar lavage fluid is made available.

Introduction: Tuberculosis (TB) is a major health problem in India. The World Health Organization has recently in 2010 endorsed the Gene Xpert MTB/RIF assay for rapid detection of smear negative and multidrug resistance tuberculosis and more recently for extra pulmonary tuberculosis. Objectives: Evaluation of role of Cartridge based nucleic acid amplification test (CBNAAT) in extra-pulmonary tuberculosis (EPTB) in comparison with Ziehl Neelsen (ZN) staining and evaluating rifampicin resistance with the same test. Materials & Methods: Extra-pulmonary samples, including pleural fluid, pus, CSF, lymph tissue & others were divided in 2 parts: one for MTB/RIF assay & other for ZN staining. Both were then compared. Results: A total of 300 extra pulmonary samples were processed in this study, which included 103 pleural fluids, 81 pus, 45 CSF, 35 Lymph node tissue, 20 ascitic fluids and 16 synovial fluid. Out of these 37% (111) patients were Gene Xpert MTB/RIF Assay positive and 36 % (40 out of 111) were ZN smear positive. M.tuberculosis was detected in 56.7% pus samples, 23.3% pleural fluid samples, 54.2% lymph node samples, 33.3 % CSF samples, 20% ascitic fluid samples and 18.7% synovial fluid samples. In this study, we found that Gene Xpert MTB/RIF assay is a rapid method for diagnosis of EPTB as compared to conventional methods along with advantage of detecting Rifampicin resistance. Conclusion: Because of its simplicity, rapidity and sensitivity, this seems to be a very novel tool for diagnosis of extra pulmonary tuberculosis from clinical samples and that it should be researched more thoroughly.

BACKGROUNDIn the present scenario, drug resistance is a huge obstacle in managing TB, as it is not only drug resistant, so difficult to treat, but also has huge financial and social burden. Objectives of the study are-1. To study the epidemiological pattern of pulmonary MDR-TB in central part of Madhya Pradesh. 2. To assess the risk factors for pulmonary MDR-TB. MATERIALS AND METHODS226 MDR-TB patients (with in-vitro resistance to rifampicin and isoniazid via line probe assay) presented to MY Hospital, Indore, were analysed over a period of one year of August 2015 to August 2016. This is a retrospective descriptive study. Analysis was done to know the epidemiological profile and assessment of risk factor for MDR-TB. RESULTS 63.3% patients were from age group 21 -40 years. 61.9% patients were male and 38.1% were female. In terms of socio-demographic profile, grand total of 72.2% (urban slums 49.6%, rural 22.6%) belonged to underdeveloped area, whereas rest belonged to urban areas. 5.8% (13) of total patients have positive family history, 10% (22) were HIV positive, 10.6% (24) were primary MDR patients, 15% (34) were treatment failure, 59.3% (134) treatment interrupted and 61.9% patients have mean body index between 10 -15 kg/m 2 (p value 0.163). CONCLUSIONAs young males are most commonly affected with MDR Tuberculosis, greater emphasis should be given on screening and treatment of young males. High percentages of patients were found to have low BMI. Awareness regarding proper nutrition and proper dietary supplements should be ensured since early adulthood. Health education and awareness program should be conducted in rural area and urban slums, as they form main source for the drug resistance TB. The bulk of patients are from treatment interrupted group, so strict compliance monitoring of all the patients on anti-tubercular treatment should be ensured. History of contact with MDR and PLHA are also independent risk factor for MDR-TB. KEYWORDSTuberculosis, MDR, LPA. HOW TO CITE THIS ARTICLE: Avashia S, Bansal D, Bhargava S, et al. A study of epidemiological pattern of multidrug resistant pulmonary tuberculosis patients presenting to a tertiary care centre in Central India. J. Evolution Med. Dent. Sci. 2018;7(08):962-964, DOI: 10.14260/jemds/2018/220 BACKGROUND MDR-TB is caused by strains of mycobacterium tuberculosis, resistant to both rifampicin and isoniazid with or without resistance to other drugs. 1 In present scenario drug resistant TB is a huge obstacle in managing tuberculosis, as it is not only difficult to treat but also has huge financial and social burden. In 2015, there were an estimated 480,000 new cases of multidrug-resistant TB (MDR-TB) and an additional 100,000 people with rifampicin-resistant TB (RR-TB) who 'Financial or Other Competing Interest': None. Submission 12-12-2017, Peer Review 01-02-2018, Acceptance 08-02-2018, Published 19-02-2018. Corresponding Author: Dr. Deepak Bansal, #11/2, Murai Mohalla, Sanyogitagani, Indore-452001, Madhya Pradesh. E-mail: drbansaldeepak@gmail.c...

Introduction: The aim of this study was to evaluate level of drug resistance in Directly Observed Treatment, short course (DOTS) CAT-II failure Pulmonary tuberculosis patients admitted for retreatment according to Indian Revised National Tuberculosis Control Programme (RNTCP). Methodology: From January 2006 to December 2008 sputum samples were collected from all patients of DOTS CAT-II failure and transported to laboratory for Mycobacterium tuberculosis culture and drug susceptibility testing (DST). Category II failure pulmonary TB includes those patients who remained sputum positive after 5 months of CAT- II TB treatment. AFB culture was done on Lowan stein Jenson slopes (Solid culture), at Choithram hospital and research center which is RNTCP accredited laboratory. Results: DST results were available for 148 sputum smear positive DOTS CAT-II failure patients. Mean age of the patients were 33.96 years (range 15-65 years), male to female ratio was 1.79:1. Of the 148 patients, 50(33.78%) had Multidrug-resistant tuberculosis (MDR-TB) and 11(7.43%) had extensively drug-resistant tuberculosis XDR-TB. Out of 148 patients, 80(54.05%) had treatment after default and 68(45.94%) had treatment failure. The prevalence of MDR-TB and XDR-TB among category-II failure pulmonary tuberculosis patients was 33.7 and 7.43 per cent. Conclusion: The prevalence of MDR-TB strains was dramatically high among patients with pulmonary tuberculosis who failed category II therapy. Capacity of drug sensitivity testing is essential for continuous monitoring of drug resistance trends, in order to assess the effi cacy of current programme and epidemiological surveillance for planning. DOI: http://dx.doi.org/10.3126/saarctb.v8i2.5894 SAARCTB 2011; 8(2): 6-10

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