Diagnosis and Interim Treatment Outcomes from the First Cohort of Multidrug-Resistant Tuberculosis Patients in Tanzania

Abstract

SettingKibong’oto National Tuberculosis Hospital (KNTH), Kilimanjaro, Tanzania.ObjectiveCharacterize the diagnostic process and interim treatment outcomes from patients treated for multidrug-resistant tuberculosis (MDR-TB) in Tanzania.DesignA retrospective cohort study was performed among all patients treated at KNTH for pulmonary MDR-TB between November 2009 and September 2011.ResultsSixty-one culture-positive MDR-TB patients initiated therapy, 60 (98%) with a prior history of TB treatment. Forty-one (67%) were male and 9 (14%) were HIV infected with a mean CD4 count of 424 (±106) cells/µl. The median time from specimen collection to MDR-TB diagnosis and from diagnosis to initiation of MDR-TB treatment was 138 days (IQR 101–159) and 131 days (IQR 32–233), respectively. Following treatment initiation four (7%) patients died (all HIV negative), 3 (5%) defaulted, and the remaining 54 (89%) completed the intensive phase. Most adverse drug reactions were mild to moderate and did not require discontinuation of treatment. Median time to culture conversion was 2 months (IQR 1–3) and did not vary by HIV status. In 28 isolates available for additional second-line drug susceptibility testing, fluoroquinolone, aminoglycoside and para-aminosalicylic acid resistance was rare yet ethionamide resistance was present in 9 (32%).ConclusionThe majority of MDR-TB patients from this cohort had survived a prolonged referral process, had multiple episodes of prior TB treatment, but did not have advanced AIDS and converted to culture negative early while completing an intensive inpatient regimen without serious adverse event. Further study is required to determine the clinical impact of second-line drug susceptibility testing and the feasibility of alternatives to prolonged hospitalization.

The Influence of Mining and Human Immunodeficiency Virus Infection Among Patients Admitted for Retreatment of Tuberculosis in Northern Tanzania

“…In a similarly treatment experienced population referred to KIDH for MDR-TB treatment, non-TB mycobacteria were found in~5% of patients. 6 Indeed, the patients that remained persistently smear positive in this current retreatment cohort and whose sputa were ultimately cultured and found to have MDR-TB may have already had amplified drug resistance on admission for retreatment. 13 Our findings emphasize the importance of rapid drug susceptibility testing in retreatment patients and caution against the reliance on sputum smear conversion as a proxy for effective treatment.…”

“…Although MDR-TB treatment began in Tanzania at KIDH in 2009, initially drug susceptibility testing was not routinely performed on retreatment patients given logistical constraints and specimen turnaround at the reference laboratory. 6 After 2013, molecular testing with either the Xpert MTB/RIF (Cepheid, Sunnyvale, CA) or the MTBDRplus (Hain Lifescience, Nehren, Germany) has been performed onsite.During the study period and excluding those with known MDR-TB, total 2,140 patients were admitted for TB treatment, of which 185 (8.6%) received a retreatment regimen ( …”

Predictors of Nutritional Status in Patients Treated for Multidrug-Resistant Tuberculosis at a Referral Hospital in Tanzania

“…The possible explanations rely partly on immunopathophysiology and hormonal mechanisms, and include increased cytokine release, such as TNF-∝ and production of gut hormone such as plasma peptin YY (PYY) [15,16]. Proper TB treatment may result in improvement of nutritional status [17][18][19]. A Cochrane review showed that both macro and micronutrient supplements during TB treatment had low to modest benefits in-terms of outcomes.…”

“…Multidrug-resistant (MDR)-TB treatment includes second-line drugs such as flouroquinolones, ethionamide and para-aminosalicylic acid, which can produce remarkable gastrointestinal intolerance [11,17]. Furthermore, patients with MDR-TB have often undergone prior treatment for TB without success and have consequently suffered from a more prolonged illness, which predisposes to malnutrition [17].…”

“…Furthermore, patients with MDR-TB have often undergone prior treatment for TB without success and have consequently suffered from a more prolonged illness, which predisposes to malnutrition [17]. In contrast to drug-susceptible TB, the relationship of malnutrition and MDR-TB has not been as thoroughly studied.…”