Drug-susceptibility Patterns of &lt;i&gt;Mycobacterium tuberculosis&lt;/i&gt; in Mpumalanga Province, South Africa: Possible Guiding Design of Retreatment Regimen

Green, E; Obi, C L; Nchabeleng, Maphoshane; Villiers, B.E. de; Sein, P P; Letsoalo, T; Hoosen, Anwar A.; Ndip, Roland N.

doi:10.3329/jhpn.v28i1.4518

Cited by 12 publications

(8 citation statements)

References 17 publications

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“…Only one (0.53%) sample was susceptible to rifampicin. This is a first report of high drug resistant MTBC Port Elizabeth; these results are higher than those that were reported by Green et al [ 22 ] who reported on 58.4% MDR-TB in the Mpumalanga Province of South Africa.…”

Section: Resultscontrasting

confidence: 64%

Molecular detection and characterization of resistant genes in Mycobacterium tuberculosis complex from DNA isolated from tuberculosis patients in the Eastern Cape province South Africa

et al. 2014

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BackgroundTuberculosis (TB) in both animals and humans is caused by Mycobacterium tuberculosis complex (MTBC) primarily transmitted by inhalation of aerosolized droplets containing the organism. Multi-drug resistance (MDR) and extensive drug resistance (XDR) are evolutionary features of Mycobacterium tuberculosis to subvert the antibiotic regimes in place. The heavy burden of TB worsened by HIV endemic in South Africa motivated for the investigation of MTBC prevalence among TB patients in Port Elizabeth and the amplification and sequencing of the DNA amplicons known to confer resistance to TB drugs.MethodsThree thousand eight hundred and ten (3810) sputum specimens were processed and DNA was isolated from sputum specimens collected from different hospitals and health care places in the Eastern Cape Province, South Africa. DNA was amplified using the Seeplex® MTB Nested ACE detection assay. The agar-dilution proportion method was used to perform drug-sensitivity testing using 7H10 Middlebrook medium. Target genes known to confer resistance to first and second-line drugs were amplified and the amplicons sequenced.ResultsOne hundred and ninety (5%) DNA samples tested positive for MTBC and from the resistant profiles of the 190 positive samples, we noted that multidrug-resistant TB was identified in 189 (99.5%) with 190 (100%) patients infected with MTB resistant to isoniazid and 189 (99.5%) having MTB resistant to rifampicin. Other percentages of drug resistance observed including 40% pre-XDR and 60% of XDR.ConclusionThis study provides valuable data on the different kinds of mutations occurring at various target loci in resistant MTBC strains isolated from samples obtained from the Eastern Cape Province. The results obtained reveal a high incidence of MDR amongst the positive samples from Eastern Cape Province, South Africa.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-479) contains supplementary material, which is available to authorized users.

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Section: Resultscontrasting

confidence: 64%

Molecular detection and characterization of resistant genes in Mycobacterium tuberculosis complex from DNA isolated from tuberculosis patients in the Eastern Cape province South Africa

et al. 2014

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“…Subba et al [ 17 ] also reported the mono-resistance among new cases to RMP and INH to be 0 and 13.33 % respectively. Green et al, reported 6.1 % resistance to RMP and 17.7 % resistance to INH from South Africa [ 26 ]. The resistance of Mycobacterium tuberculosis to RMP and INH is an alarming marker of MDR-TB [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…This may be explained by the extensive use of streptomycin for the treatment of other bacterial infections. The use of standard anti-tubercular therapy in mono-DR-TB and poly-DR-TB posses a great risk of treatment failure leading to the development of MDR-TB in case of the mono-drug and poly-drugs (non-MDR) resistant cases [ 26 ]. The differences in the susceptibility patterns of M. tuberculosis in other countries and in Nepal, may be due to the difference in effectiveness of tuberculosis control program in different countries and difference in other risk factors like previous TB treatment, improper and/or incomplete treatment, smoking habit, poverty, illiteracy, migration to/from high MDR-TB prevalence areas, alcoholism, poor housing, overcrowding and homelessness in different countries.…”

Section: Discussionmentioning

confidence: 99%

Drug susceptibility patterns of the Mycobacterium tuberculosis isolated from previously treated and new cases of pulmonary tuberculosis at German-Nepal tuberculosis project laboratory, Kathmandu, Nepal

Thapa¹,

Pant

Khatiwada³

et al. 2016

Antimicrob Resist Infect Control

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BackgroundMultidrug resistant tuberculosis (MDR-TB) is a serious public health problem in Nepal. It is a major obstacle for the control of the tuberculosis. The main objectives of this study were to determine the prevalence of the multidrug resistant pulmonary tuberculosis and to evaluate the drug susceptibility patterns of Mycobacterium tuberculosis isolated from previously treated and newly diagnosed cases of pulmonary tuberculosis.MethodsA cross-sectional study was conducted from March 2013 to August 2013 at German-Nepal tuberculosis project (GENETUP) laboratory, Kathmandu, Nepal. For this the sputum samples from total of 153 (49 new and 104 previously treated) suspected pulmonary tuberculosis patients were used. The diagnosis of the tuberculosis was performed by using fluorescent microscopy and culture, while the drug susceptibility testing of Mycobacterium tuberculosis was performed by proportion method. Lowenstein-Jensen (L-J) medium was used for the culture of Mycobacterium tuberculosis and the colonies grown were identified on the basis of the colony morphology, pigment production and biochemical characteristics.ResultsThe prevalence of MDR-TB among all the cases of culture positive pulmonary tuberculosis was 15.6 %. The rate of MDR-TB among previously treated culture positive tuberculosis patients was 19.4 % and that among newly diagnosed culture positive pulmonary tuberculosis cases was 7.1 %. The highest rate of resistance of Mycobacterium tuberculosis, was toward streptomycin (24.4 %) followed by isoniazid (23 %), rifampicin (17.8 %) and ethambutol (15.6 %). Among the total of MDR-TB cases among previously treated patients, highest percentage of the cases were relapse (61.1 %) followed by chronic (16.7 %).ConclusionsThe high prevalence of DR/MDR-TB in our study reflects poor implementation of tuberculosis control program. On the basis of the drug susceptibility patterns of M. tuberculosis we found in our study, we recommend to include ethambutol instead of streptomycin in the multidrug therapy for the treatment of tuberculosis patients in Nepal. Further, due to high rate of MDR-TB among previously treated patients, we do not recommend to use first line drugs for the treatment of pulmonary tuberculosis among previously treated patients.

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“…Two recent follow-up studies evaluating this regimen observed, even after cure, very high rates of recurrence in TB patients with MDR-TB at base-line [ 21 , 22 ]. Notwithstanding, most TB programmes in low-income countries in sub-Saharan Africa treat, empirically, every year 10-20% of their TB patients using this regimen [ 2 , 15 , 19 ]. The design of NTP retreatment regimens depends on the epidemiological context, the program's performance, and the means available.…”

Section: Discussionmentioning

confidence: 99%

Early results of systematic drug susceptibility testing in pulmonary tuberculosis retreatment cases in Cameroon

Noeske¹,

Voelz²,

Fon³

et al. 2012

BMC Res Notes

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BackgroundThe number of pulmonary tuberculosis (PTB) patients reported with resistance to first-line anti-tuberculosis drugs after a standardized retreatment regimen in Cameroon is increasing. Hence, the National Tuberculosis Control Program (NTP) implemented, in one of the ten Regions of the country, a pilot programme aimed at performing routine drug susceptibility testing (DST) for previously treated PTB cases. The objectives of the programme were to evaluate the feasibility of monitoring drug resistance among retreatment cases under programme conditions and to measure the presence and magnitude of anti-TB drug resistance in order to inform NTP policies.FindingsThis retrospective cohort study was conducted in the Littoral Region of Cameroon in 2009. It included all sputum smear positive (SM+) PTB cases registered for retreatment. TB cases were identified and classified according to World Health Organization (WHO) recommendations for national TB programs. Bacterial susceptibility testing to first-line anti-TB drugs was performed using standard culture methods. In 2009, 5,668 TB cases were reported in the Littoral Region, of which 438 (7.7%) were SM + PTB retreatment cases. DST results were available for 216 (49.4%) patients. Twenty six patients (12%) harbored multi-drug resistant (MDR) strains. Positive treatment outcome rates were particularly low in retreatment patients with MDR-TB (46.2%; 95% CI: 27.1-66.3). Thirteen MDR-TB patients were treated using a standardized MDR treatment regimen. Delivery of laboratory results took on average 17 (12-26) weeks.ConclusionsWHO-recommended routine DST in retreatment patients seems feasible in Cameroon. However, coverage needs to be improved through better management. Moreover, diagnostic delay should be shortened by introducing more rapid diagnostic tools. The high risk of MDR in standard regimen failure cases virtually rules out the standard retreatment regimen for such patients without prior DST.

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Drug-susceptibility Patterns of <i>Mycobacterium tuberculosis</i> in Mpumalanga Province, South Africa: Possible Guiding Design of Retreatment Regimen

Cited by 12 publications

References 17 publications

Molecular detection and characterization of resistant genes in Mycobacterium tuberculosis complex from DNA isolated from tuberculosis patients in the Eastern Cape province South Africa

Molecular detection and characterization of resistant genes in Mycobacterium tuberculosis complex from DNA isolated from tuberculosis patients in the Eastern Cape province South Africa

Drug susceptibility patterns of the Mycobacterium tuberculosis isolated from previously treated and new cases of pulmonary tuberculosis at German-Nepal tuberculosis project laboratory, Kathmandu, Nepal

Early results of systematic drug susceptibility testing in pulmonary tuberculosis retreatment cases in Cameroon

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