Evaluation of Rifampicin-resistant Tuberculosis in Pediatric Patients by GeneXpert MTB/RIF

Yıl 2021, Cilt: 11 Sayı: 02, 81 - 87, 15.06.2021

Ashish William Yogita Raı Ravinder Kaur

https://doi.org/10.5799/jmid.951506

Öz

Objectives: India has the largest burden of MDR-TB worldwide, with an annual incidence of 1,30 000 patients. Multidrug-resistant tuberculosis (MDR-TB) carries a poor prognosis, a high mortality rate, and treatment success rates as low as 65%. The mortality in India is estimated to be about 480,000 per year. The aim of the study was to evaluate Rifampicin-resistant Tuberculosis and its distribution by GeneXpert in a tertiary care hospital.
Methods: A total of 2864 samples were processed from the patients attending outpatient departments and indoor wards as per the pediatrician's request. Acid-fast bacilli (AFB) smear microscopy was done on all samples by Acid-fast staining for early diagnosis followed by GeneXpert MTB/RIF (CBNAAT) testing. Specimens were transported and stored at 2–8 °C prior to processing for CBNAAT. Results were read and reported within 2 hours.
Results: A total of 2864 samples were tested for TB using CBNAAT (including 645 [22.5%] extra-pulmonary and 2219 [77.5%] pulmonary samples). The test results were positive in a total of 346 (12%) samples by CBNAAT. The positivity is highest in the age group >10 years and in sputum samples (37.28%) followed by pus samples (23.26%) in pulmonary and extrapulmonary distribution. Out ZN staining was positive in 244 (8.5%) specimens. There were 102 (29.5%) CBNAAT positive specimens which showed negative results for Acid-fast bacilli (70.52% Sensitivity). Among 346 TB-positive patients, 10.46% samples were pulmonary and 17.67% were extrapulmonary. It was observed that in positive CBNAAT patients, the prevalence of Rifampicin resistance was 12.72% i.e. 44 samples which include 31(13.36%) and 13(11.40%) pulmonary and extra-pulmonary samples respectively. Among the Rifampicin resistant samples, there were 29.55% samples that were extrapulmonary.
Conclusion: GeneXpert MTB/RIF is a very rapid diagnostic assay that provides information regarding the mutation pattern of RIF resistance in MTB isolates. J Microbiol Infect Dis 2021; 11(2):81-87.

Anahtar Kelimeler

CBNAAT, Tuberculosis, GeneXpert MTB/RIF

Kaynakça

• 1. Glaziou P, Floyd K, Raviglione MC. Global epidemiology of tuberculosis. Semin Respir Crit Care Med 2018; 39:271-85.
• 2. World Health Organisation. Global Tuberculosis Report, 2019.
• 3. Guidelines on programmatic management of drug resistant tuberculosis in India, RNTCP 2017.
• 4. Weiss P, Chen W, Cook VJ, et al. Treatment outcomes from community-based drug resistant tuberculosis treatment programs: a systematic review and meta-analysis. BMC Infect Dis 2014; 14: 333.
• 5. Central TB Division, Directorate General of Health Services, Ministry of Health with Family Welfare: Government of India. New Delhi: 2017. Revised National Tuberculosis Control Program. National Strategic Plan for Tuberculosis Elimination 2017–25.
• 6. Marais BJ, Gie RP, Schaff HS, et al. The natural history of childhood intra-thoracic tuberculosis; a critical review of literature from the pre-chemotherapy era. Int J Tuberc Lung Dis 2004; 8:392-402.
• 7. Jenkins HE, Tolman AW, Yuen CM, et al. Incidence of multidrug-resistant tuberculosis disease in children: systematic review and global estimates. Lancet 2014; 383:1572–9.
• 8. Dodd PJ, Gardiner E, Coghlan R, Seddon JA. Burden of childhood tuberculosis in 22 high-burden countries: a mathematical modelling study. Lancet Glob Health 2014; 2:e453–459.
• 9. Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF system for the diagnosis of pulmonary and extrapulmonary TB in adults and children: policy update. Geneva, World Health Organization, 2013.
• 10. Rachow A, Clowes P, Saathoff E, et al. Increased and expedited case detection by Xpert MTB/RIF assay in childhood tuberculosis: a prospective cohort study. Clin Infect Dis 54. 2012: 1388-96.
• 11. Haldar S, Bose M, Chakrabarti P, et al. Improved laboratory diagnosis of tuberculosis-The Indian experience. Tuberculosis (Edinb) 2011; 91(5): 414-426.
• 12. Ichhpujani RL, Agarwal SP, Chauhan LS. Diagnostic needs and status of new diagnostic tools for tuberculosis. In: Agarwal SP, Chauhan LS.Tuberculosis control in India. Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India, 2005, pp. 165-78.
• 13. Bianchi L, Galli L, Moriondo M, et al. Interferon-gamma release assay improves the diagnosis of tuberculosis in children. Pediatr Infect Dis J 2014; 28(6): 510-4.
• 14. Pai M, Nathavitharana R. Extrapulmonary Tuberculosis: New Diagnostics and New Policies. Indian J Chest Dis Allied Sci 2014; 56(2): 71-73.
• 15. World Health Organization (2017) Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF assay for the diagnosis of pulmonary and extrapulmonary TB in adults and children: policy update. World Health Organization, Geneva, Switzerland.
• 16. Lawn SD, Nicol MP. Xpert® MTB/RIF assay: Development, evaluation and implementation of a new rapid molecular diagnostic for tuberculosis and rifampicin resistance. Future Microbiol 2011; 6:1067 82.
• 17. Helb D, Jones M, Story E, et al. Rapid detection of mycobacterium tuberculosis and rifampicin resistance by use of on demand, near-patient technology. J Clin Microbiol 2010; 48:229-37.
• 18. Ajaykumar T, San S, Shiju S, Balasangameshwara VH, Kumar P. External Quality Assessment System for Sputum Smear Microscopy in India: Operational and Technical Implementation Aspects. NTI Bulletin 2005; 41(1 & 2):18-32.
• 19. Xpert MTB/RIF Implementation Manual: Technical and Operational ‘How-To’; Practical Considerations. Geneva: World Health Organization; 2014. Annex 2, Standard Operating Procedure (SOP) for processing extrapulmonary specimens (CSF, lymph nodes and other tissues) for Xpert MTB/RIF Assay.
• 20. Arega B, Menbere F, Getachew Y. Prevalence of rifampicin resistant Mycobacterium tuberculosis among presumptive tuberculosis patients in selected governmental hospitals in Addis Ababa, Ethiopia. BMC Infect Dis 2019; 19, 307.
• 21. Nicol MP, Workman L, Isaacs W, et al. Accuracy of the Xpert MTB/RIF test for the diagnosis of pulmonary tuberculosis in children admitted to hospital in Cape Town, South Africa: a descriptive study. Lancet Infect Dis 2011;11(11): 819-824.
• 22. Sekadde MP, Wobudeya E, Joloba ML, et al. Evaluation of the Xpert MTB/RIF test for the diagnosis of childhood pulmonary tuberculosis in Uganda: a cross-sectional diagnostic study. BMC Infect Dis 2013; 13:133.
• 23. Phuljhele S, Beck P, Sinha A, Saroj AK. Diagnostic accuracy of CBNAAT (Gene-Xpert) Vs liquid culture in clinically diagnosed presumptive childhood tuberculosis admitted in Pt. J.N.M. Medical College & Dr. Bhim Rao Ambedkar Memorial Hospital, Raipur (C.G.). Int J Pediatr Res.2019; 6(09):467-473.
• 24. Jain SK, Ordonez A, Kinikar A, et al. Pediatric Tuberculosis in Young Children in India: A Prospective Study. Biomed Res Int. 2013; 2013:783698.
• 25. Verma D, Malhotra B, Goyal S, Shah T, Gupta KN. Prevalence of MDR-TB and mutational pattern in rpoB gene of Mycobacterium tuberculosis at Eastern Rajasthan. Microcon 2014. (38th National Conference of Indian Association of Medical Microbiologist) 2014; MP39:253.
• 26. Kaur R, Jindal N, Arora S, Kataria S. Epidemiology of Rifampicin Resistant Tuberculosis and Common Mutations in rpoB Gene of Mycobacterium tuberculosis: A Retrospective Study from Six Districts of Punjab (India) Using Xpert MTB/RIF Assay. J Lab Physicians 2016; 8(2):96‐100.
• 27. Kasat S, Biradar M, Deshmukh A, Jadhav S, Deshmukh H. Effectiveness of CBNAAT in the diagnosis of extrapulmonary tuberculosis. Int J Res Med Sci2018; 6:3925-3928.
• 28. Sharma SK, Mohan A. Extrapulmonary tuberculosis. Indian J Med Res 2004; 120:316–53.
• 29. WHO (2012) Tuberculosis countries profiles. World Health Organization.
• 30. Gurung R, Bhattacharya SK, Pradhan B, Gurung S, Singh Y. Phenotypic characterisation and drug sensitivity testing of mycobacteria isolated from extrapulmonary tuberculosis. Kathmandu Univ Med J 2010; 8(29):57–61.
• 31. Chakraborty S, Chakraborty A, Talukder T, Mukherjee M, Chatterjee T. Prevalence of Mycobacterium tuberculosis Strains Isolated from Both Pulmonary and Extra Pulmonary Samples and Their Resistance to Rifampicin: A Study from Kolkata and Surrounding Suburbs. J Tuberculosis Res 2016; 4:61-71.