Increasing Prevalence of Pediatric Drug-resistant Tuberculosis in Mumbai, India, and Its Outcome

Shah, Miti A; Shah, Ira

doi:10.1097/inf.0000000000002040

Cited by 21 publications

(11 citation statements)

References 5 publications

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“…The ability of Xpert® MTB/RIF and phenotypic detection of TB drug resistance cannot be underscored as it can pave a way to complementary and confirmatory WGS in early detection of resistance. Studies have shown phenotypic susceptibility tests to serve as reference standards [25], and that both Xpert assay and DST can provide information on polyresistance in pre-XDR-TB [26] despite varying sensitivities [27,28]. The current practice in diagnosing drug resistant tuberculosis is through the WHO-approved probe-based assays like Xpert® MTB/RIF (Cepheid, USA) for RIF [16] and either genotype MTBDRplus for RIF and INH or genotype MTBDRsl (Hain Lifesciences, Germany) for aminoglycosides/capreomycin and fluoroquinolones that must be confirmed with culture-based DST [29].…”

Section: Discussionmentioning

confidence: 99%

Whole genome sequencing of Mycobacterium tuberculosis isolates and clinical outcomes of patients treated for multidrug-resistant tuberculosis in Tanzania

Katale

Mbelele

Lema³

et al. 2020

BMC Genomics

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Background: Tuberculosis (TB), particularly multi-and or extensive drug resistant TB, is still a global medical emergency. Whole genome sequencing (WGS) is a current alternative to the WHO-approved probe-based methods for TB diagnosis and detection of drug resistance, genetic diversity and transmission dynamics of Mycobacterium tuberculosis complex (MTBC). This study compared WGS and clinical data in participants with TB.Results: This cohort study performed WGS on 87 from MTBC DNA isolates, 57 (66%) and 30 (34%) patients with drug resistant and susceptible TB, respectively. Drug resistance was determined by Xpert® MTB/RIF assay and phenotypic culture-based drug-susceptibility-testing (DST). WGS and bioinformatics data that predict phenotypic resistance to anti-TB drugs were compared with participant's clinical outcomes. They were 47 female participants (54%) and the median age was 35 years (IQR): 29-44). Twenty (23%) and 26 (30%) of participants had TB/HIV coinfection BMI < 18 kg/m 2 respectively. MDR-TB participants had MTBC with multiple mutant genes, compared to those with mono or polyresistant TB, and the majority belonged to lineage 3 Central Asian Strain (CAS). Also, MDR-TB was associated with delayed culture-conversion (median: IQR (83: 60-180 vs. 51:30-66) days). WGS had high concordance with both culture-based DST and Xpert® MTB/RIF assay in detecting drug resistance (kappa = 1.00). Conclusion: This study offers comparison of mutations detected by Xpert and WGS with phenotypic DST of M. tuberculosis isolates in Tanzania. The high concordance between the different methods and further insights provided by WGS such as PZA-DST, which is not routinely performed in most resource-limited-settings, provides an avenue for inclusion of WGS into diagnostic matrix of TB including drug-resistant TB.

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Section: Discussionmentioning

confidence: 99%

Whole genome sequencing of Mycobacterium tuberculosis isolates and clinical outcomes of patients treated for multidrug-resistant tuberculosis in Tanzania

Katale

Mbelele

Lema³

et al. 2020

BMC Genomics

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“…Mumbai contributes 22% of TB cases reported in the state of Maharashtra [ 15 ]. The city is known as a TB and DR-TB hotspot of the country and has a high proportion of MDR-TB with fluoroquinolone resistance and advanced TB resistance profiles [ 16 – 18 ]. M-East Ward is one of the wards in Mumbai which has lowest development index and majority of the residents live in slums [ 19 ].…”

Section: Methodsmentioning

confidence: 99%

Treatment outcomes of children and adolescents receiving drug-resistant TB treatment in a routine TB programme, Mumbai, India

Dhakulkar¹,

Das

Sutar³

et al. 2021

PLoS ONE

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Background Childhood and adolescent drug-resistant TB (DR-TB) is one of the neglected infectious diseases. Limited evidence exists around programmatic outcomes of children and adolescents receiving DR-TB treatment. The study aimed to determine the final treatment outcomes, culture conversion rates and factors associated with unsuccessful treatment outcome in children and adolescents with DR-TB. Methods This is a descriptive study including children (0–9 years) and adolescents (10–19 years) with DR-TB were who were initiated on ambulatory based treatment between January 2017-June 2018 in Shatabdi hospital, Mumbai, India where National TB elimination programme(NTEP) Mumbai collaborates with chest physicians and Médecins Sans Frontières(MSF) in providing comprehensive care to DR-TB patients. The patients with available end-of-treatment outcomes were included. The data was censored on February 2020. Result A total of 268 patients were included; 16 (6%) of them were children (0–9 years). The median(min-max) age was 17(4–19) years and 192 (72%) were females. Majority (199, 74%) had pulmonary TB. Most (58%) had MDR-TB while 42% had fluoroquinolone-resistant TB. The median(IQR) duration of treatment (n = 239) was 24(10–25) months. Median(IQR) time for culture-conversion (n = 128) was 3(3–4) months. Of 268 patients, 166(62%) had successful end-of-treatment outcomes (cured-112; completed treatment-54). Children below 10 years had higher proportion of successful treatment outcomes (94% versus 60%) compared to adolescents. Patients with undernutrition [adjusted odds-ratio, aOR (95% Confidence Interval, 95%CI): 2.5 (1.3–4.8) or those with XDR-TB [aOR (95% CI): 4.3 (1.3–13.8)] had higher likelihood of having unsuccessful DR-TB treatment outcome. Conclusion High proportion of successful treatment outcome was reported, better than global reports. Further, the nutritional support and routine treatment follow up should be strengthened. All oral short and long regimens including systematic use of new TB drugs (Bedaquiline and Delamanid) should be rapidly scaled up in routine TB programme, especially for the paediatric and adolescent population.

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“…The proportion of LTFU among childhood TB patients ranges from 4 to 37% [52][53][54][55][56][57]. Among the children with drug-resistant TB, it ranges from 5 to 19.09% [58][59][60]. These figures are much similar to those of the adult population.…”

Section: Proportion Of Ltfumentioning

confidence: 98%

Loss to Follow-Up (LTFU) during Tuberculosis Treatment

Lin¹

2019

Healthcare Access - Regional Overviews [Working Title]

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Loss to follow-up (LTFU) is a serious issue in the field of tuberculosis (TB) since it can lead to TB outbreaks and drug resistance. The proportion of LTFU patients differs among different countries, regions, year, and institutions. In some countries, the number of patients that were LTFU nearly reaches half of the total patients. Underlying factors such as age, gender, education, residence, financial factors, migration, and social stigma are discussed in this chapter. These factors should always be taken into consideration whenever a treatment program is designed. Suggestions have been made regarding some interventions that could potentially solve the problem of LTFU. With these points in mind, an ambitious approach should be taken to reduce the number of LTFU patients up to zero.

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Increasing Prevalence of Pediatric Drug-resistant Tuberculosis in Mumbai, India, and Its Outcome

Abstract: DR-TB is increasing in Mumbai, India. Based on the DST results, individualised therapy would be recommended.

Cited by 21 publications

References 5 publications

Whole genome sequencing of Mycobacterium tuberculosis isolates and clinical outcomes of patients treated for multidrug-resistant tuberculosis in Tanzania

Whole genome sequencing of Mycobacterium tuberculosis isolates and clinical outcomes of patients treated for multidrug-resistant tuberculosis in Tanzania

Treatment outcomes of children and adolescents receiving drug-resistant TB treatment in a routine TB programme, Mumbai, India

Loss to Follow-Up (LTFU) during Tuberculosis Treatment

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