The Impact of Isoniazid Resistance on the Treatment Outcomes of Smear Positive Re-Treatment Tuberculosis Patients in the State of Andhra Pradesh, India

Deepa, Dorai; Achanta, Shanta; Jaju, Jyoti; Rao, K. Bhaskara; R, Samyukta; Claassens, Mareli; Kumar, Ajay M. V.; Ph, Vishnu

doi:10.1371/journal.pone.0076189

Cited by 26 publications

(29 citation statements)

References 7 publications

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“…During the initial period of our transplant program (40 liver transplants), the significance and management of these healed granulomas in the explanted liver were debated because no clear guidelines were available. Clinical equipoise existed because potentially up to 40% to 70% of Indians were likely to have healed occasional granulomas in their tissues, infection was often remote, immunosuppression after transplantation was lifelong (whereas isoniazid prophylaxis lasted 9 months), and there were high rates of reported isoniazid resistance by M. tuberculosis . When 2 of these index patients developed posttransplant TB, we re‐evaluated our protocol to initiate isoniazid prophylaxis for 9 months at 6 weeks after transplantation for all patients with granulomas in the explanted liver without an alternative cause.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical equipoise existed because potentially up to 40% to 70% of Indians were likely to have healed occasional granulomas in their tissues, infection was often remote, immunosuppression after transplantation was lifelong (whereas isoniazid prophylaxis lasted 9 months), and there were high rates of reported isoniazid resistance by M. tuberculosis. 24 When 2 of these index patients developed posttransplant TB, we re-evaluated our protocol to initiate isoniazid prophylaxis for 9 months at 6 weeks after transplantation for all patients with granulomas in the explanted liver without an alternative cause. This was thought to be adequate to reduce the risk of reactivation during the period when the intensity of immunosuppression was highest.…”

Section: Discussionmentioning

confidence: 99%

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Tuberculosis in liver transplant recipients: Experience of a South Indian liver transplant center

et al. 2014

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Tuberculosis (TB) is a serious disease for liver transplant recipients (LTRs). Data on post-liver transplant TB from high-burden countries are scant. The aims of this study were to describe the prevalence of TB in LTRs from a high-prevalence area and to analyze the risk factors for the development of post-liver transplant TB. We performed a retrospective review of our database and a case-control study of identified cases with TB and age-matched LTRs without TB. The overall prevalence of TB in LTRs was comparable to the prevalence of TB in LTRs from low-prevalence countries (5/214 or 2.3%). A low rate of interferon-g release assay (IGRA) testing before liver transplantation was observed (68/214 or 31%). Most patients were screened clinically and with chest radiography alone before transplantation. TB developed variably after transplantation [median 5 72 days, interquartile range (IQR) 5 534 days]. The presentation was mostly extrapulmonary and/or disseminated (4/5 or 80%). When cases with posttransplant TB were compared with matched healthy LTRs, the presence of unexplained granulomas in explants (2/5 or 40%, P 5 0.01) was the only factor associated with the development of TB. When all explants showing granulomas were reviewed, TB (52.9%) remained the most common cause; however, in almost half (47.1%), other attributable causes were found. Patients were treated with a standard daily regimen for a median of 12 months (IQR 5 7.5 months). Posttransplant TB was associated with a high mortality rate (2/5 or 40%). In conclusion, we observed a low prevalence of TB in LTRs from a highprevalence region. The presence of granulomas suggestive of TB in liver explants warrants isoniazid prophylaxis in the absence of disease. Post-liver transplant TB is associated with a high mortality rate. The roles of routine IGRA testing and isoniazid prophylaxis in a high-prevalence setting urgently need to be studied. Tuberculosis (TB) continues to be a global scourge. India has the highest TB burden and accounts for approximately one-fifth (21%) of the global disease burden. It is estimated that approximately 40% of the Indian population is infected with the TB bacillus, and the prevalence of smear-positive pulmonary cases remains approximately 75/100,000.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Tuberculosis in liver transplant recipients: Experience of a South Indian liver transplant center

et al. 2014

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“…Some observational studies from a variety of settings (with and without adjustment for treatment regimen and other confounders) have found similar results, including the previously cited study examining deaths in TB meningitis patients. 10;32;33 Other studies have not found an association between resistance and negative outcomes. 34;35 A large retrospective cohort of patients receiving short course chemotherapy from six countries was also less clear cut, showing an association between INH resistance and the risk of treatment failure in retreatment cases and weaker statistical evidence among new cases.…”

Section: The Influence Of Resistance On Treatment Outcomesmentioning

confidence: 98%

Isoniazid-resistant tuberculosis: a cause for concern?

Stagg¹,

Lipman

McHugh³

et al. 2017

int j tuberc lung dis

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SUMMARY The drug isoniazid (INH) is a key component of global tuberculosis (TB) control programmes. It is estimated, however, that 16.1% of TB disease cases in Former Soviet Union countries and 7.5% of cases outside of those settings have non-multidrug resistant (MDR) INH resistance. Resistance has been linked to poorer treatment outcomes, post-treatment relapse and death, at least for specific sites of disease. Multiple genetic loci are associated with phenotypic resistance, but the relationship between genotype and phenotype is complex. This restricts the use of rapid sequencing techniques as part of the diagnostic process to determine the most appropriate treatment regimens for patients. The burden of resistance also influences the usefulness of INH preventative therapy (IPT). Despite seven decades of the use of INH our knowledge in key areas- such as the epidemiology of resistant strains, their clinical consequences, and their exact role in fuelling the MDR TB epidemic- is limited. The importance of non-MDR INH resistance needs to be re-evaluated both globally and by national TB control programmes.

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“…Individuals were classified as symptomatic if they had a cough for over 2 weeks, weakness, chest pain, and fever for over 1 month or hemoptosis on any occasion over six months [8]. Gene expert is used in the detection of MDR-TB [9].…”

Section: Methodsmentioning

confidence: 99%

Clinical Study on Prevalence of Multi Drug Resistant Tuberculosis in Khammam District, Telangana – An Observational Study

Mohammad¹,

Yeluru²,

P³

et al. 2017

RPHS

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Background: The aim of the study is to evaluate the prevalence of multi drug resistant tuberculosis in Khammam district. The objective is to create awareness among healthcare personnel and patients regarding MDR-TB. The study was conducted over a period of six months, i.e., December 2016 – June 2017. Result: A total of 54 MDR-TB cases were studied. According to age groups 32 subjects are in the young and middle age groups which comprise a total of about 59.1 whereas in early age there are 6.8%. Many variables are considered in this study out of which alcohol was rated as highest because 59.2% subjects in the study were alcoholics. A total of 31.8% smokers was found out. Diabetes was also a variation with 27.8% subjects suffering. A total of 18.5% of subjects was suffering from TB with HIV. Conclusion: The study reveals that the subjects suffered from resistance to category-I drugs and hence they are transferred to category-IV drugs. Tuberculosis is a disease that mainly affects the people of age groups 20-40 and is more prevalent in males than that of females. Variables like alcohol consumption rated as highest risk factor, followed by smoking, diabetes and HIV respectively.

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The Impact of Isoniazid Resistance on the Treatment Outcomes of Smear Positive Re-Treatment Tuberculosis Patients in the State of Andhra Pradesh, India

Cited by 26 publications

References 7 publications

Tuberculosis in liver transplant recipients: Experience of a South Indian liver transplant center

Tuberculosis in liver transplant recipients: Experience of a South Indian liver transplant center

Isoniazid-resistant tuberculosis: a cause for concern?

Clinical Study on Prevalence of Multi Drug Resistant Tuberculosis in Khammam District, Telangana – An Observational Study

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