Mycobacterium tuberculosis drug-resistance in previously treated patients in Ouagadougou, Burkina Faso

Sangaré, Lassana; Diandé, Souba; Kouanda, Séni; Dingtoumda, B. I.; Mourfou, Adama; Ouédraogo, Frédéric; Sawadogo, Issaka; Nebié, Baloua; Gueye, Abdoulaye; Sawadogo, LT; Traoré, Ali

doi:10.4103/1596-3519.62619

Cited by 12 publications

(10 citation statements)

References 12 publications

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“…In Lagos, for instance, 32 % of all new patients with their first ever episode of TB were already presenting with widely circulating MDR isolates. Our findings support previous publications from Nigeria [8–12] and Burkina Faso [13, 14]; however, variations in the respective MDR prevalence estimates of these publications are considerable, due to differences in sampling strategy, collection time points and location, making an overall comparison difficult. Burkina Faso, Nigeria and Niger were the only WANETAM countries that previously reported XDR isolates [3, 15].…”

Section: Discussionsupporting

confidence: 86%

The emerging threat of pre-extensively drug-resistant tuberculosis in West Africa: preparing for large-scale tuberculosis research and drug resistance surveillance

Gehre

Otu

Kendall

et al. 2016

BMC Med

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BackgroundDrug-resistant tuberculosis (TB) is a global public health problem. Adequate management requires baseline drug-resistance prevalence data. In West Africa, due to a poor laboratory infrastructure and inadequate capacity, such data are scarce. Therefore, the true extent of drug-resistant TB was hitherto undetermined. In 2008, a new research network, the West African Network of Excellence for Tuberculosis, AIDS and Malaria (WANETAM), was founded, comprising nine study sites from eight West African countries (Burkina Faso, The Gambia, Ghana, Guinea-Bissau, Mali, Nigeria, Senegal and Togo). The goal was to establish Good Clinical Laboratory Practice (GCLP) principles and build capacity in standardised smear microscopy and mycobacterial culture across partnering laboratories to generate the first comprehensive West African drug-resistance data.MethodsFollowing GCLP and laboratory training sessions, TB isolates were collected at sentinel referral sites between 2009–2013 and tested for first- and second-line drug resistance.ResultsFrom the analysis of 974 isolates, an unexpectedly high prevalence of multi-drug-resistant (MDR) strains was found in new (6 %) and retreatment patients (35 %) across all sentinel sites, with the highest prevalence amongst retreatment patients in Bamako, Mali (59 %) and the two Nigerian sites in Ibadan and Lagos (39 % and 66 %). In Lagos, MDR is already spreading actively amongst 32 % of new patients. Pre-extensively drug-resistant (pre-XDR) isolates are present in all sites, with Ghana showing the highest proportion (35 % of MDR). In Ghana and Togo, pre-XDR isolates are circulating amongst new patients.ConclusionsWest African drug-resistance prevalence poses a previously underestimated, yet serious public health threat, and our estimates obtained differ significantly from previous World Health Organisation (WHO) estimates. Therefore, our data are reshaping current concepts and are essential in informing WHO and public health strategists to implement urgently needed surveillance and control interventions in West Africa.

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Section: Discussionsupporting

confidence: 86%

The emerging threat of pre-extensively drug-resistant tuberculosis in West Africa: preparing for large-scale tuberculosis research and drug resistance surveillance

Gehre

Otu

Kendall

et al. 2016

BMC Med

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“…The isolates were identified by acid-fast stain, growth rate, morphology, resistance to TCH, growth on LJ+Pyruvate and reactions to usual biochemistry tests (niacin, nitrate reductase, catalase activity at 22°C and 70°C). Drug susceptibility testing (DST) was performed by a simplified version of the proportion method described elsewhere (12,13).…”

Section: Bacteriological Investigationsmentioning

confidence: 99%

HIV infection and mycobacterium tuberculosis drug-resistance among tuberculosis patients in Burkina Faso, West Africa

Sangaré¹,

Diandé²,

Ouédraogo³

et al. 2010

Af J Clin Exp Micro

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The aim of this study was to compare the drug-resistance patterns of Mycobacterium tuberculosis strains among pulmonary tuberculosis patients, according to their HIV serostatus, in Burkina Faso. Tuberculosis (TB) patients were classified in new and previously treated cases by using a structured questionnaire. Susceptibility testing to isoniazid, streptomycin, rifampicin and ethambutol was done by the proportion method. Association between HIV-serostatus and drug-resistant TB was assessed with χ 2 tests, and the statistical significance was set to P<0.05. Of 316 (249 new, 67 previously treated) patients included in the study, 68.7% were males and 28.8% were HIV-positive; females (36.4%) were more infected than males (25.3%), (P=0.04). The average age of the patients was 37.24±12.76 years [11-75years]. Most of the patients infected with HIV were aged from 15 to 44 years and were females, (P=0.01). In the new cases of TB, the difference between HIV-positive and HIV-negative patients was not statistically significant neither for the MDR-TB (P=0.40), nor for the resistant-TB to any drug (P=0.26). However, the difference was significant for the resistance to isoniazid and streptomycin alone (P=0.04). Among the previously treated patients, although there was more MDR-TB and more resistance to any drug in HIV-negative patients than among HIV-positive patients, these differences also were not statistically significant (P=0.54 and P=0.63, respectively). This study found no significant difference between TB/HIV-negative and TB/HIV-positive patients according to the resistance patterns to anti-TB medications, excepted the resistance to isoniazid in new cases and to isoniazid and streptomycin in all patients took globally. These results encourage the collaboration between the programs against TB and HIV to prevent rapid diffusion of drug-resistant TB and high mortality in patients living with HIV/AIDS as recommended by the World Health Organization.

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“…The resistance rate to EMB has gradually increased in some regions and approaches 50% in re-treated TB patients (4)(5)(6). In China, the resistance rate to EMB increased from 6.52% in 2007 to 17.18% in 2010 (7).…”

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confidence: 99%

Mutations in the embC-embA Intergenic Region Contribute to Mycobacterium tuberculosis Resistance to Ethambutol

Cui

Song

et al. 2014

Antimicrob Agents Chemother

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The rapid increase in Mycobacterium tuberculosis resistance to ethambutol (EMB) threatens the diagnosis and treatment of tuberculosis (TB). We investigated the role of mutations in the embC-embA intergenic region (IGR) in EMB-resistant clinical strains from east China. A total of 767 M. tuberculosis clinical strains were collected and analyzed for their drug susceptibility to EMB using the MGIT 960 system and MIC assay, and the embC-embA IGRs of these strains were sequenced. The transcriptional activity of the embC-embA IGR mutations was examined by reporter gene assays in recombinant Mycobacterium smegmatis strains, and the effect of IGR mutations on its binding to EmbR, a transcription regulator of embAB, was analyzed by gel mobility shift assays. Correlation coefficient analysis showed that the embC-embA IGR mutation is associated with EMB resistance. The clinical strains carrying IGR mutations had a much higher level of embA and embB mRNA as well as higher MICs to EMB. IGR mutations had higher transcriptional activity when transformed into M. smegmatis strains. Mutated IGRs bound to EmbR with much higher affinity than wild-type fragments. The sensitivity of molecular drug susceptibility testing (DST) with IGR mutations as an additional marker increased from 65.5% to 73.5%. Mutations of the embC-embA IGR enhance the binding of EmbR to the promoter region of embAB and increase the expression of embAB, thus contributing to EMB resistance. Therefore, identification of IGR mutations as markers of EMB resistance could increase the sensitivity of molecular DST.T uberculosis (TB) remains a major global health problem. It affects millions of people each year and is the second leading cause of death from an infectious disease worldwide. In 2012, an estimated 8.6 million people developed TB, and 1.3 million died from the disease. The emergence of drug-resistant strains of Mycobacterium tuberculosis, especially those that are multidrug resistant (MDR) and extensively drug resistant (XDR), has posed a serious threat to global TB control programs (1). An estimated 3.6% of new patients and 20.2% of previously treated patients have MDR-TB, and there were 450,000 new cases of MDR-TB worldwide in 2012 (2). Given the alarming rise of drug-resistant TB, the identification of drug resistance genes is critical for the detection and treatment of TB. Much progress has been made to identify gene mutations in specific loci of the M. tuberculosis genome as the molecular basis for TB drug resistance and as drug targets for the development of anti-TB drugs. Although an association of mutations in these resistance genes with drug resistance has been observed, the exact role these genes play in the development of drug resistance is not fully understood. Furthermore, a significant number of anti-TB drug-resistant strains do not carry these mutations, suggesting that unknown gene mutations or variations are involved in the development of anti-TB drug resistance.Ethambutol (EMB) is an essential first-line anti-TB drug that inhibits the biosy...

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Mycobacterium tuberculosis drug-resistance in previously treated patients in Ouagadougou, Burkina Faso

Abstract: In previously treated patients, the level of resistance of M. tuberculosis complex to commonly used anti-tuberculosis drugs is very high in Ouagadougou. Our results showed that multidrug-resistant tuberculosis could be a public health problem in Burkina Faso.

Cited by 12 publications

References 12 publications

The emerging threat of pre-extensively drug-resistant tuberculosis in West Africa: preparing for large-scale tuberculosis research and drug resistance surveillance

The emerging threat of pre-extensively drug-resistant tuberculosis in West Africa: preparing for large-scale tuberculosis research and drug resistance surveillance

HIV infection and mycobacterium tuberculosis drug-resistance among tuberculosis patients in Burkina Faso, West Africa

Mutations in the embC-embA Intergenic Region Contribute to Mycobacterium tuberculosis Resistance to Ethambutol

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