Decreasing prevalence of multi-drugs resistant Mycobacterium tuberculosis in Nashik City, India

Year 2013, Volume: 3 Issue: 01, 12 - 17, 01.03.2013

Arun Punaji More Ramkrishna Panchamrao Nagdawane Aniket K Gangurde

https://doi.org/10.5799/ahinjs.02.2013.01.0072

Abstract

Objective: In India, increasing prevalence of multi-drug resistant tuberculosis (MDR) has aggravated the control of tuberculosis problem. In many urban and semi-urban regions of India, no surveillance data of multidrug resistance in Mycobacterium tuberculosisis available. Methods: A surveillance study on multidrug resistance was carried out in semi-urban and rural regions in and around Nashik City of Maharashtra, India. The surveillance study was conducted in this region found that the prevalence of combined resistance to first and second-line anti-tuberculosis drugs is remarkably high. The isolates of M. tuberculosis was identified and subjected to drug susceptibility testing. The patterns of drug susceptibility of isolates of M. tuberculosis during the periods 2000 and 2004 were compared with drug susceptibility patterns of the organisms during the period 2008 to 2011. Results: The 260 isolates identified as M. tuberculosis show mean drug resistance prevalence of 45.6% for more than any two drugs and the MDR rate as 37% in the years 2000 to 2004 whereas 305 isolates of the organism show mean drug resistance prevalence of 30.2% and the MDR rate as 25% in the years 2008 to 2011. Conclusion: The researcher found that, though the prevalence of multidrug resistance to the drugs tested is remarkably high, it has come down noticeably during the past seven years due to efforts of State Government and strict implementation of treatment guidelines of WHO by the physicians.

Keywords

MDR-TB, XDR-TB, DOTS, drug-resistance prevalence rate

Decreasing prevalence of multi-drugs resistant Mycobacterium tuberculosis in Nashik City, India

Abstract

Amaç: Hindistan’da, çok ilaca dirençli tüberküloz (ÇİD) prevalansının artışı tüberküloz sorununun kontrolünü güçleştirdi. Hindistan’ın birçok kentsel ve yarı kentsel bölgelerinde, Mycobacterium tuberculosis suşlarında çoklu ilaç direnci gösteren sürveyans verisi mevcuttur.Yöntemler: Çoklu ilaç direnci üzerine olan bu sürveyans çalışması Maharashtra, Hindistan Nashik şehri ve çevresindeki yarı kentsel ve kırsal bölgelerde yürütüldü. Sürveyans çalışması, ilk ve ikinci seçenek anti-tüberküloz ilaçlara karşı kombine direnç sıklığı önemli ölçüde yüksek bulunan bu bölgede yürütüldü. M. tuberculosis izolatları tanımlandı ve ilaç duyarlılık testine tabi tutuldu. M. tuberculosis izolatlarının 2000 ve 2004 dönemi ile 2008-2011 dönemindeki ilaç duyarlılık paternleri karşılaştırıldı.Bulgular: 260 izolat M. tuberculosis olarak tanımlandı, 2000-2004 yıllarında herhangi iki ilaçtan fazla ilaca direnç gösterme oranı ortalama % 45,6 ve ÇİD oranı % 37 iken 2008-2011 yıllarında 305 izolatda ortalama direnç oranı % 30,2 ve ÇİD oranı % 25 idi.Sonuç: Çoklu ilaç direncinin prevalansı oldukça yüksek bulunmasına rağmen, bu oran devletin çabaları ve tedavi kılavuzlarının hekimler tarafından sıkı bir şekilde uygulanması ile son yedi yıl içinde belirgin bir düşüş gösterdi

Keywords

MDR-TB, XDR-TB DOTS, ilaç direnci sıklığı

References

• Janmeja AK, Raj B. Acquired drug resistance in tuberculosis in Haryana, India. J Assoc Physicians India 1998;46:194-198.
• CDC. Initial therapy for tuberculosis in the era of multi drug resistance: Recommendation of the advisory council for the elimination of tuberculosis. MMWR 1993;42 (RR-7):1-8.
• Goble M, Isemen MD, Madsen LA, Waite D, Ackerson L, Horsburgh CR Jr. Treatment of 171 patients with pulmonary tuberculosis resistant to isoniazid and rifampin. New Engl J Med 1993;328:527-532.
• Sar B, Keo C, Leng C, et al. Anti-tuberculosis drug resistance and HIV co-infection in Phnom Penh, Cambodia. Southeast Asian J Trop Med Public Health. 2009;40:104-107.
• Pereira M, Tripathy S, Inamdar V, et al. Drug resistance pat- tern of Mycobacterium tuberculosis in seropositive and sero- negative HIV-TB patients in Pune, India. Indian J Med Res 2005;121:235-239.
• Van der Werf TS. High initial resistance in pulmonary tubercu- losis in Ghana. Tubercle 1989;70:249-255.
• Frieden TR, Sterling T, Pablos-Mendez A, Kilburn JO, Cauthen GM, Dooley SW. The emergence of drug resistant tubercu- losis in New-York city. N Engl J Med 1993 25; 328:521-526.
• Park YS, Hong SJ, Boo YK, et al. The national status of tu- berculosis using nationwide medical records survey of pa- tients with tuberculosis in Korea. Tuberc Respir Dis (Seoul) 2012;73:48-55.
• Chan PC, Huang SH, Yu MC, et al. Effectiveness of a gov- ernment-organized and hospital-initiated treatment for mul- tidrug-resistant tuberculosis patients-a retrospective cohort study. PLoS One 2013;8:e57719.
• Paramsivan CN. An overview of drug resistant tuberculosis in India. Ind J Tuberc 1998;45:75-77.
• WHO. World health organization guidelines for surveillance of drug resistance in tuberculosis. WHO/TB/96. WHO Re- port, 1996.
• Almeida D, Rodrigues C, Udwadia ZF, et al. Incidence of multi-drug resistant tuberculosis in urban and rural India and implications for prevention. Clin Infect Dis 2003;36:e152- 154.
• Guidelines for surveillance of drug resistance in tuberculo- sis. World Health Organization, WHO, Geneva, Switzerland. WHO/HTM/TB/2009. 422. http://whqlibdoc.who.int/publica- tions/2009/9789241598675_eng.pdf
• R Development Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Com- puting, Vienna, Austria, 2011. http://www.R-project.org/.
• Virasakdi Chongsuvivatwong. epicalc: Epidemiological cal- culator, 2012. R package version 2.14.1.6. {http://CRAN.R- project.org/package=epicalc}
• Holst E, Mitchison DA, Radhakrishna S. Examination of smears for tubercle bacilli by fluorescence microscopy. Ind J Med Res 1959;47:495-499.
• WHO. Laboratory services in TB control. Parts i, ii and iii. Technical Report WHO/tb/98.258, World Health Organiza- tion, Geneva, 1998.
• Kubica GP. Differential identification of mycobacteria VII. Key to features for identification of clinically significant Mycobac- teria. Am Rev Resp 1973;107:9-21.
• Almeida D, Rodrigues C, Udwadia ZF, et al. Incidence of multi-drug resistant tuberculosis in urban and rural India and implications for prevention. Clin Infect Dis 2003;36e:152- 154.
• Malhotra B, Phatak S, Vyas L, et al. Drug susceptibility pat- terns of Mycobacterium tuberculosis isolate at Jaipur. Indian J Med Microbiol 2002;20:76-78.
• Dye C, Garnett GP, Sleeman K, Williams BG Prospects for worldwide tuberculosis control under the WHO dots strategy: directly observed short-course therapy. Lancet 1998;352:1886-1891.
• Borgdorff MW, Floyd K and Broekmans JF Interventions to reduce tuberculosis mortality and transmission in low- and middle-income countries. Bull World Health Organ 2002;80:217-227.
• Styblo K, Bumgarner R. Tuberculosis can be controlled with existing technologies: evidence in Tuberculosis surveillance research unit; progress report 1991. Hague, Netherlands: KNCV, pages 60-72, 1991.