Drug resistance among extrapulmonary TB patients: Six years experience from a supranational reference laboratory

Abstract

Background & objectives:There is limited information available about the drug resistance patterns in extrapulmonary tuberculosis (EPTB), especially from high burden countries. This may be due to difficulty in obtaining extrapulmonary specimens and limited facilities for drug susceptibility testing. This study was undertaken to review and report the first and second-line anti-TB drug susceptibility patterns in extrapulmonary specimens received at the National Institute for Research in Tuberculosis (NIRT), Chennai, India, between 2005 and 2012.Methods:Extrapulmonary specimens received from referring hospitals were decontaminated and cultured using standard procedures. Drug susceptibility testing (DST) for Mycobacterium tuberculosis was done by absolute concentration or resistance ratio methods for the first and the second line anti-TB drugs.Results:Between 2005 and 2012, of the 1295 extrapulmonary specimens, 189 grew M. tuberculosis, 37 (19%) cases were multidrug resistant (MDR) while one was extensively drug resistant (XDR). Specimen-wise MDR prevalence was found to be: CSF-10 per cent, urine-6 per cent, fluids and aspirates-27 per cent, pus-23 per cent, lymph nodes-19 per cent. Resistance to isoniazid and ethionamide was found to be high (31 and 38%, respectively).Interpretation & conclusions:Drug resistance including MDR-TB was observed in a significant proportion of extrapulmonary specimens referred for DST. Access to culture and DST for extrapulmonary specimens should be expanded. Guidelines for MDR-TB management should have explicit sections on extra-pulmonary tuberculosis and training on laboratory techniques is urgently required.

Drug resistance in intestinal tuberculosis: A reason to worry?

“…Our current data are comparable to those reported by Ye et al .,9 but show higher percentage of MDR cases (Table 3). These rates are lower than that reported by Dusthackeer et al 11. in pulmonary (single‐drug resistance in 23.8% and MDR in 21%) and extra‐pulmonary (27.5% and 19%, respectively) TB.…”

“…In a high‐burden country like India, 10–15% of patients are reported to be isoniazid resistant, while 2–3% are MDR 10. Single‐drug resistance of 27% and multidrug resistance of 19% have been reported for extra‐pulmonary (glandular and pleural) TB 11. Data on presence of resistance and its pattern in ITB are sparse.…”

Does Drug-Resistant Extrapulmonary Tuberculosis Hinder TB Elimination Plans? A Case from Delhi, India

“…The median (IQR) number of days from diagnosis to registration for treatment was 15 [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ] days, whereas from diagnosis to initiation of treatment was 14 days [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ].…”

“…Besides the risk factors identified in this study, some of which are non-modifiable, a shorter and easier-to-follow DR-TB treatment regimen with newer oral drugs such as bedaquiline or delamanid is probably the answer to reducing mortality and LTFU in this patient group. With the recent evidence from trials and large observational cohorts, the WHO stance has also departed from conventional treatment approaches for MDR TB in favour of shorter regimens with noninjectables [ 14 , 26 , 27 ]. However, newer drugs are being given only for pulmonary DRTB at present in India.…”

“…Another study in Mumbai showed resistance in 29% of Mycobacterium isolates in extrapulmonary specimens [ 13 ]. A similar study from Chennai found that 37/189 (19%) of extrapulmonary TB specimens were multidrug-resistant, while one was extensively drug-resistant (XDR) [ 14 ].…”