Drug-resistant tuberculosis: is India ready for the challenge?

Chatterjee, S.; Poonawala, Husain; Jain, Yogesh

doi:10.1136/bmjgh-2018-000971

Cited by 52 publications

(39 citation statements)

References 15 publications

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“…The authors mentioned that resistance to fluoroquinolones is 21% in non-MDR and 36% in MDR patients and resistance to aminoglycosides such as amikacin, capreomycin, or kanamycin is 7% in new patients. In addition, resistance to ethionamide and para-aminosalicylic acid (PAS) was 11% in new patients [ 73 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Osteoarticular Tuberculosis: Perceptions, Protocols, Practices, and Priorities in the Endemic and Non-Endemic Areas of the World—A WAIOT View

Agashe

Johari²,

Shah³

et al. 2020

Microorganisms

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There has been a major resurgence of tuberculosis (TB) and drug-resistant tuberculosis in the last few decades. Although it has been brought under control in most Western countries, it is still a major cause of death in endemic regions like India. Osteoarticular tuberculosis (OA TB) forms a small proportion of the total cases of tuberculosis. Perceptions and practices of orthopedic surgeons are entirely different in endemic and non-endemic regions around the world, due to the vast difference in exposure. Literature from endemic areas puts stress on clinico-radiological diagnosis and empirical anti-tubercular treatment (ATT). Such practices, although non-invasive, simple to implement, and economical, carry a significant risk of missing TB mimics and developing drug resistance. However, OA TB is still perceived as a “diagnostic enigma” in non-endemic regions, leading to a delay in diagnosis. Hence, a high index of suspicion, especially in a high-risk population, is needed to improve the diagnosis. Evolving drug resistance continues to thwart efforts to control the disease globally. This review article discusses the perceptions and practices in different parts of the world, with India as an example of the endemic world, and lays down priorities for overcoming the challenges of diagnosing osteoarticular TB.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of Osteoarticular Tuberculosis: Perceptions, Protocols, Practices, and Priorities in the Endemic and Non-Endemic Areas of the World—A WAIOT View

Agashe

Johari²,

Shah³

et al. 2020

Microorganisms

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“…In 2017, under the RNTCP, India performed 1.07 million Xpert MTB/RIF tests, 93 989 LPA tests, and second-line DST for 26 832 samples. 19 However, to diagnose the estimated 2.8 million cases of TB and 150 000 cases of MDR-TB every year, the number of laboratories and the number of samples tested in each laboratory will need to be scaled up. Contrary to the widespread belief that previous treatment is a major risk factor for MDR-TB, recent studies suggest that most MDR-TB is transmitted rather than acquired, accounting for 96% of new and 61% of previously treated cases of MDR-T. 20 Modelling studies estimate that 85% of TB in India in 2032 will be MDR-TB, all due to primary transmission.…”

Section: Discussionmentioning

confidence: 99%

“…24 Initial INH resistance increases incidence rates of treatment failure and relapse compared with pan-sensitive strains (incidence rate ratio 10.9 and 1.8, respectively). 25 Research priorities include the development of a strong evidence base for the optimal use of preventive therapy in high-risk populations, determining the protective efficacy of novel vaccines, developing sensitive and rapid diagnostic tests for DR-TB (directly from sputum samples), identifying biomarkers to predict future disease risk, identifying pragmatic methods to enhance case detection, testing new models of care to reduce time to effective treatment, developing treatment regimens that are short, safe and durable and improving infection control in all high-transmission settings. 26 A staggered approach is currently being used to diagnose MDR TB in India.…”

Section: Discussionmentioning

confidence: 99%

Progression from tuberculosis to multi drug resistance-TB in revised national tuberculosis control programme: perspectives from health system care givers

Kumar

Rana

Sundram

et al. 2019

Int J Community Med Public Health

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Background: The aims and objectives were to study the progression from tuberculosis to multi drug resistance-TB in revised national tuberculosis control programme: perspectives from health system care givers.Methods: The study was carried out in TB Sanatorium ITKI, Sadar Hospital Ranchi and RIMS Ranchi. The interview of various health personnel including SAHIYAs was taken using a semi-structured questionnaire based on programmatic management of multi drug resistant tuberculosis guidelines -2016.Results: Among Doctors knowledge level was good compared to other health personnel which had mean value 7.33 (±2.79), laboratory technician 3.45 (±2.64), STS 4.67 (±1.59), Sahiya 2.1 (±0.73). Regarding capacity enhancement level all health personnel needed refresher trainings in which doctors got 4.67 (±1.58), laboratory technician 3.45±2.64, STS 1.72±0.34, and Sahiya 0.5±0.52. Specially sahiya needs training regarding MDR-TB because they are the connecting link between health system and community. Regarding execution level, Doctors got 1.86 (±0.74), laboratory technician 1.64 (±0.56), STS 1.64 (±0.56) and Sahiya (ASHA) 2.2 (±0.44). Sahiya were better than other health personnel at execution level.Conclusions: Advocacy, communication, and social mobilization are important aspects of TB control, Policy makers and administrators should be sensitized for need of adequate and sustained funding for TB control to ensure quality capacity building. They need to provide continuous and quality training of staff at different levels and retention of trained staff and periodic reviews to identify gaps and take corrective steps.

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“…Tuberculosis is one of the major health problem in India, it kills nearly half a million people every year. 1 In India diagnosis & treatment of tuberculosis is based on Revised National Tuberculosis Control Programme (RNTCP) guidelines. 2 Ethambutol is one of the first line anti tubercular drugs used along with isoniazid, rifampicin and pyrazinamide.…”

Section: Introductionmentioning

confidence: 99%

Ethambutol induced optic neuritis: a case series

Sruthi¹,

Anuradha²

2019

Int J Basic Clin Pharmacol

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Ethambutol is one of the first line chemotherapeutic agents used in the treatment of tuberculosis used both in the intensive and continuation phase according to the new Revised National Tuberculosis Control Program guidelines. Patient acceptability is rather good with this drug as it produces comparatively lesser adverse effects. The most important and serious side effect reported is optic neuritis, resulting in loss of visual acuity, color vision and field defects. The incidence of optic neuritis is generally directly proportional to the dose and duration of ethambutol therapy. Here we report four cases of ethambutol induced optic neuritis in patients on fixed dose combinations (FDC) of ethambutol, isoniazid, pyrazinamide and rifampicin who presented in Ophthalmology OPD in a span of 2 months, between June and July 2019. Contradictory to the rare occurrence of ethambutol induced optic neuritis this comparatively higher incidence of optic neuritis is alarming. We observed that the presentation of ethambutol induced optic neuritis can vary and dose of ethambutol along with other factors can also contribute to it. So proper pre-treatment evaluation, dosage adjustment, periodic monitoring and early detection have a significant role in prevention and treatment of ethambutol induced optic neuritis.

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Drug-resistant tuberculosis: is India ready for the challenge?

Cited by 52 publications

References 15 publications

Diagnosis of Osteoarticular Tuberculosis: Perceptions, Protocols, Practices, and Priorities in the Endemic and Non-Endemic Areas of the World—A WAIOT View

Diagnosis of Osteoarticular Tuberculosis: Perceptions, Protocols, Practices, and Priorities in the Endemic and Non-Endemic Areas of the World—A WAIOT View

Progression from tuberculosis to multi drug resistance-TB in revised national tuberculosis control programme: perspectives from health system care givers

Ethambutol induced optic neuritis: a case series

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