Drug susceptibility profiles of pulmonary Mycobacterium tuberculosis isolates from patients in informal urban settlements in Nairobi, Kenya

Kerubo, Glennah; Amukoye, Evans; Niemann, Stefan; Kariuki, Samuel

doi:10.1186/s12879-016-1920-5

Cited by 10 publications

(7 citation statements)

References 23 publications

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“…Increasing resistance towards second line drugs (SLD's) is a major global threat leading to pre-XDR and XDR-TB which has high mortality rates due to limited treatment options and lower rates of treatment success [1,2]. Timely diagnosis and treatment remains an utmost challenge in order to stop circulating XDR-TB strains and further amplification of resistance [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Performance of Genotype MTBDRsl V2.0 over the Genotype MTBDRsl V1 for detection of second line drug resistance: An Indian perspective

et al. 2020

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Genotype MTBDRsl Version 1 (V1.0) was recommended as an initial test for rapid detection of pre-extensively drug resistant (pre-XDR) and extensively drug resistant tuberculosis (XDR-TB). However, in recent years a number of novel mutations are identified that confer resistance. Thus, Genotype MTBDRsl V2.0 was endorsed by WHO. Though, Genotype MTBDRsl V2.0 has been rolled out in national TB programme in 2018, there is dearth of data from India on its performance for second line drug susceptibility testing (DST). For this, performance of new version was evaluated on 113 MDR-TB isolates. The results showed that 39 (34.5%) of these isolates were resistant to FQ and 7 (6.2%) were XDR by Genotype MTBDRsl V2.0. Amongst the FQ resistant isolates most prevalent mutation was ΔWT3-D94G (17; 38.6%) and N538D (12; 85.7%). Among the AG/CP and KAN resistant isolates most common mutation in the rrs region was ΔWT1-A1401G (5; 71.4%) and C-14T (2; 28.5%) in eis gene. Second line Bactec MGIT-960 detected 40 (35.4%) isolates as resistant to FQ and 6 (5.3%) as XDR isolates, whereas Genotype MTBDRsl V1.0 also detected 39 (34.5%) as resistant to FQ but missed 2 isolates in correctly identifying as XDR (5; 4.4%). Thus, concordance of second line Bactec MGIT-960 with Genotype MTBDRsl V2.0 was similar (100%) for FQ detection but it has improvised the diagnostic sensitivity for correctly identifying XDR isolates. Nevertheless, the cost of Genotype MTBDRsl V2.0 remains an issue for screening of second line drug (SLDs) resistance from countries with high burden of MDR-TB.

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Section: Introductionmentioning

confidence: 99%

Performance of Genotype MTBDRsl V2.0 over the Genotype MTBDRsl V1 for detection of second line drug resistance: An Indian perspective

et al. 2020

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“…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 .…”

Section: Resultsmentioning

confidence: 99%

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

2022

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Background The rate of multidrug-resistant tuberculosis is increasing at an alarming rate throughout the world. It is becoming an emerging public health problem in East Africa. The prevalence of multidrug-resistant tuberculosis among pulmonary tuberculosis positive individuals in the region has not been thoroughly investigated. Aim The aim of this systematic review and meta-analysis is to estimate the pooled prevalence of multidrug-resistant tuberculosis among newly diagnosed and previously treated pulmonary tuberculosis cases in East African countries. Methods English published articles were systematically searched from six electronic databases: PubMed, EMBASE, Scopus, Science direct, Web of Science, and Google scholar. The pooled prevalence of multidrug-resistant tuberculosis and associated risk factors were calculated using Der Simonian and Laird’s random Effects model. Funnel plot symmetry visualization confirmed by Egger’s regression asymmetry test and Begg rank correlation methods was used to assess publication bias. A total of 16 articles published from 2007 to 2019 were included in this study. STATA 14 software was used for analysis. Results Out of 1025 articles identified citations, a total of 16 articles were included in final meta-analysis. The pooled prevalence of multidrug-resistant tuberculosis among newly diagnosed tuberculosis cases and previously treated tuberculosis patients was 4% (95%CI = 2–5%) and 21% (95%CI: 14–28%), respectively. Living conditions, lifestyles (smoking, alcohol use, and drug abuse), previous medical history, diabetes history, and human immunodeficiency virus infection were risk factors contributing to the higher prevalence of multidrug-resistant tuberculosis in East Africa. Conclusion The review found a significant prevalence of multidrug-resistant tuberculosis in the region. An early diagnosis of tuberculosis and rapid detection of drug-resistant Mycobacterium tuberculosis is a critical priority to identify patients who are not responding to the standard treatment and to avoid transmission of resistant strains. It is also very important to strengthen tuberculosis control and improve monitoring of chemotherapy.

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“…Ndung'u PW et al, (30.0%, 2012) [44], Kerubo G et al, (30.0%, 2016) [45] and Yonge SA et al, (48.6%, 2017) [46] in Kenya; and Aung WW et al, (27.7%, 2015) [47] in Myanmar. However, a lower rate of resistance of M. tuberculosis strains in new presumptive pulmonary TB cases was reported in the previous studies by Biadglegne F et al, (6.7%, 2014) [48] in Ethiopia.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of first-and second-line anti-tuberculosis drug resistance in new pulmonary tuberculosis cases in Addis Ababa metropolitan area, Ethiopia

Akalu

Tessema

Sinshaw

et al. 2023

Preprint

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Background: Conventional wisdom wrongly holds that the microbiological of M. tuberculosis complex in clinical specimens via culture and phenotypic drug susceptibility testing allow people to be correctly diagnosed, necessary for early detection of drug resistance strains and ensure timely selection of effective treatment regimen. The aim of this study was to characterize first-and second-line anti-tuberculosis drug resistance profiles among new pulmonary tuberculosis cases in Addis Ababa metropolitan area, Ethiopia. Methods: A prospective cross-sectional study was conducted between October 2019 and June 2021 among bacteriologically confirmed new presumptive pulmonary tuberculosis cases. GeneXpert MTB/RIF Assay was utilized for initial testing and early detection of rifampicin resistance. Mycobacterial culture and drug susceptibility testing were performed against FOUR first-line and ELEVEN second-line anti-TB drugs using BD BACTEC™ MGIT™ 960 automated liquid culture system. Results: A total of 156 M. tuberculosis complex isolates were successfully recovered using BD BACTEC™ MGIT™ 960 automated liquid culture system and were subjected to drug susceptibility testing. Males account for 53.8 % (84/156). The median age of the study participants was 30.0 years. Of all the study participants, 58.3 % (91/156) were married, and 76.9% (120/156) were urban residents. Overall, we identified 14.1% (22/156) resistance to at least one anti-TB drug and 85.9% (134/156) pan-susceptible M. tuberculosis strains. Further, 7.1% (11/156) of isolates were monoresistant, 5.8% (9/156) of isolates were MDR-TB strains, and 3.8% (6/156) of isolates were resistant to all first-line anti-TB drug regimens. Interestingly, all isolates were susceptible to all recently recommended second-line anti-TB drugs, and none of these isolates were found to be pre-XDR or XDR-TB. The rate of RR-TB detected was 10.9% (17/156) and 5.8% (9/156) using GeneXpert MTB/RIF Assay and BD BACTECTM MGITTM 960 SIRE liquid culture system, respectively. The sensitivity, specificity, PPV, NPV, accuracy, and Kappa value were 100%, 94.6%, 52.9%, 100%, 94.9%, and 0.667, respectively. Conclusion: The rate of MDR-TB in new pulmonary TB cases remained high at fivefold the national and nearly twofold the global estimated rate. The rate of monoresistance against anti-TB drugs was also high. The absence of resistance against recommended second-line anti-TB drugs was quite encouraging. However, the high rate of resistance against Ethionamide would mean that its inclusion in the regimens may not have therapeutic benefit in this geographic area. Furthermore, the low specificity of GeneXpert MTB/RIF Assay might introduce a significant rate of (47.1%; 8/17) false rifampicin resistance leading the patient toerroneous MDR-TB category and placing on an unnecessary second-line anti-TB-treatment regimen. Enhanced efforts are required to progressively validate and harmonize rapid molecular diagnostics against reference methods to address the diagnosis challenges and improve patient outcomes.

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Drug susceptibility profiles of pulmonary Mycobacterium tuberculosis isolates from patients in informal urban settlements in Nairobi, Kenya

Cited by 10 publications

References 23 publications

Performance of Genotype MTBDRsl V2.0 over the Genotype MTBDRsl V1 for detection of second line drug resistance: An Indian perspective

Performance of Genotype MTBDRsl V2.0 over the Genotype MTBDRsl V1 for detection of second line drug resistance: An Indian perspective

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

Epidemiology of first-and second-line anti-tuberculosis drug resistance in new pulmonary tuberculosis cases in Addis Ababa metropolitan area, Ethiopia

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