Anti-tuberculosis drug resistance pattern among pulmonary tuberculosis patients with or without HIV infection in Mwanza, Tanzania

Abstract

Anti-tuberculosis drug resistance is a major problem in tuberculosis (TB) control, particularly multi-drug resistance TB (MDR-TB). The objective of this study was to determine the prevalence of primary and acquired anti-TB drug resistance among newly diagnosed pulmonary TB (PTB) and relapse cases. Sputa were collected from newly diagnosed and relapse PTB patients. Drug susceptibility tests (DST) were performed on sputum culture positive isolates of Mycobacterium tuberculosis using resistance ratio method on four first-line anti-TB drugs: rifampicin, isoniazid, ethambutol and streptomycin. Demographic and anthropometric information was collected and HIV status was determined. Of the 523 culture positive isolates, DST results were available for 503 (96%), 455 were new and 48 were relapse cases. Resistance to at least one of the four drugs was observed in 7.8% (39/503) of the isolates, 7.3% (33/455) were new and 12.5% (6/48) were from relapse cases. Mono resistance to isoniazid was higher in both among new 45.5% (15/33) and relapse 50.0% (3/6) cases. Resistance to rifampicin and streptomycin alone was equal 4/33 (12.1%) and only among new cases. Resistance to ethambutol alone was only one among new cases. Overall MDR-TB prevalence was 2.4% (12/503), nine were new and three were relapse cases. MDR-TB was 17.9% (7/39) for rifampicin and isoniazid. Prevalence of HIV was 43.3% and was similar among new and relapse cases and not risk factor for drug resistance. Majority of PTB patients (52%) had BMI below 18 kg/m2. Those with BMI greater than 18 kg/m2 were more likely to develop drug resistance than those with BMI below 18 kg/m2 (P=0.004). With the resurgence of TB and the high prevalence of HIV among TB patients, prevalence of drug resistance is still low both among new and relapses cases. Despite the current low drug resistance, there is a need for continuous monitoring of the resistance.

Rifampicin and isoniazid drug resistance among patients diagnosed with pulmonary tuberculosis in southwestern Uganda

“…Studies have shown that previous TB drug exposure, especially in inadequate or inappropriate doses, can result in an increased risk of developing mono-drug or multidrugresistant tuberculosis [25][26][27][28]. The findings of this study of higher prevalence of MTB drug resistance among previously treated patients is consistent with findings of other Ugandan studies [25,29,30] and other neighbouring countries [4,31,32]. These high levels of drug resistance among previously treated patients raise concerns about TB treatment compliance and the successful application of drug resistance preventive measures such as directly observed…”

Prevalence of multidrug-resistant tuberculosis in East Africa: A systematic review and meta-analysis

“…East African countries such as 5 in Ethiopia (Admassu, 2011 [ 23 ], Mekonnen et al, 2015 [ 24 ], Brhane et al, 2017 [ 25 ], Biresaw et al, 2018 [ 26 ], Girum et al, 2018 [ 27 ]), 2 in Kenya (Kerubo et al, 2016 [ 28 ], Huerga et al, 2017 [ 29 ]), 1 in Rwanda (Umubyeyi et al, 2007 [ 30 ]), 3 in Sudan (Eldin et al, 2011. [ 31 ], Sabeel et al, 2017 [ 32 ], Eldirdery et al, 2017 [ 33 ]), 2 in Tanzania (Chonde et al, 2010 [ 34 ], Range et al, 2012 [ 35 ]) and 3 in Uganda (Lukoye et al, 2011 [ 36 ], Lukoye, 2013 [ 3 ], Okethwangu et al, 2019 [ 37 ]) were used in this systematic review and meta-analysis indicated in S2 Table . The references of all 16 studies included for the meta-analysis are provided in supporting information ( S1 File ).…”

“…The overall prevalence of MDR-TB among previously treated TB cases was 21% (95%CI: 14–28%); I 2 = 99.1%, P≤0.001 [ Fig 5 ]. The prevalence of MDR-TB among previously treated TB cases of each of the studies included in this systematic review ranges from 1% (95%CI: -0.00–1.00) by Range et al [ 35 ] to 91% (95%CI: 81–101) by Okethwangu et al [ 37 ].…”