PURPOSE: Multidrug Resistant Tuberculosis (MDR-TB) is a significant problem not only in India but all over the Globe. The most common factor responsible for emergence of MDR-TB is the inadequate tuberculosis drug therapy in the past. These cases most commonly occur in the patients like treatment failure, relapse cases, defaulter cases and those who had multiple courses of incomplete therapy. We evaluated such previously treated patients for prevalence of MDR-TB.
METHODS: We retrospectively analyzed the culture and drug sensitivity testing (DST) records of suspected MDR-TB patients registered in our specialty clinic at department of Pulmonary Medicine. Sputum samples of a total of 154 culture positive cases were subjected to DST during the period of 01.01.2007 through 31.12.2009. MDR-TB was defined as disease caused by bacilli showing resistant to Isoniazid and Rifampicin. Our patients included adequately / inadequately treated failure, relapse, and defaulter cases under our national control program (RNTCP) and those who had taken non RNTCP standard daily regimens.
RESULTS: Out of 154 patients whose sputum specimens were evaluated by DST studies, MDR-TB was detected in 63 cases (40.9%). The age of MDR-TB patients ranged from 8-84 years. Of these 63 MDR-TB cases, 27 were resistant to Rifampicin and Isoniazid (HR), 32 to Streptomycin, Isoniazid & Rifampicin (SHR), I to Isoniazid Rifampicin & ethambutol (HRE) and 3 revealed resistance to Streptomycin, Isoniazid, Rifampicin, and ethambutol (SHRE). The prevalence of MDR-TB among previously treated Pulmonary Tuberculosis patient was 40.9%.
CONCLUSIONS: The prevalence of MDR-TB in previously treated pulmonary tuberculosis patients was highly significant.
CLINICAL IMPLICATIONS: In view of very high prevalence of MDR-TB in previously treated patients; the latter deserve proper evaluation by culture and DST using rapid diagnostic molecular tests such as line probe assays. The early detection and effective treatment of such patient will not only harvest good cure rate but will also minimize the transmission of the MDR-TB in the community.
DISCLOSURE: The following authors have nothing to disclose: Ashok Janmeja, P. Mohapatra, Deepak Aggarwal
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