Study of prevalence Rifampicin and/ or Isoniazid drug resistance among newly diagnosed cases of sputum smear positive pulmonary tuberculosis at tertiary care centre

Introduction

Drug-resistant pulmonary tuberculosis (DR-TB) is a major public health problem that considerably affects the present TB control programme in India. Tuberculosis (TB) control efforts are threatened by the emergence of Mycobacterium tuberculosis strains that are resistant to first-line and second line drugs. In 2017, TB was responsible for an estimated 1.3 million deaths among HIV-negative people, and an additional 300 000 deaths from TB among HIV-positive people. There were an estimated 10.0 million new cases of TB, equivalent to 133 cases per 100 000 population. Globally in 2017, there were an estimated 558 000 new cases of rifampicin resistant TB (RR-TB), of which almost half were in three countries: India (24%), China (13%) and the Russian Federation (10%). Among RR-TB cases, an estimated 82% had multidrug-resistant TB (MDR-TB). Globally, 3.5% of new TB cases and 18% of previously treated cases had MDR/RR-TB, with the highest proportions (>50% in previously treated cases) in countries of the former Soviet Union. Previous treatment for TB is the most important risk factor for development of MDR-TB, but naïve patients are also at risk due to either spontaneous mutations or transmission of drug-resistant strains.1 The risk of transmission of resistant strains from close contacts is increasing because of the growing burden of MDR-TB patients. Therefore, there is high likelihood that what initially seems to be drug-sensitive TB in a treatment-naïve patient might in fact be MDR TB. Therefore, there is a need to determine the prevalence of MDR-TB among new cases of sputum-positive pulmonary TB

Materials and Methods

This study was conducted in department of respiratory medicine , Government medical college , Nagpur which is also a nodal DR TB centre attached to IRL.

Results

Maximum patients were in age group of 18-30 years followed by 31-40 years

Figure 1

Distribution of patients according to age

Figure 2

Distribution of patients according to Sex

Figure 3

Distribution of patients according to body mass index

Almost all patient had BMI less than 25 which suggest undernutrition.

Figure 4

Ditribution of patients according to drug resistance pattern

Discussion

The present study was prospective observational study conducted in department of respiratory medicine, Government medical college, Nagpur to find out prevalence of drug resistance in newly diagnosed sputum smear positive cases. The most cost effective measure to treat the drug susceptible tuberculosis is provision and implementation of good quality DOTS thereby preventing the spread of emergence of drug resistant tuberculosis. Maximum patients were in age group of 18-30 years followed by 31-40 years (Figure 1). The mean age of patient was 36.43(+/- 14.05) years. This demographic profile was similar to other studies by Rawat J et al,2 Ajaz et al3 and V.Agwan et al.4 There were greater number of male patients than female patients in this study with 75.2% males and 24.8% females (Figure 2). These results were similar with studies by SK Sharma et al5 Jethani S etal.6

In this study, about 86% patients were malnourished (Figure 3),12.8% patients were in the normal range, 1.2% were pre obese, with median BMI (15.38 +/- 3.51). Kasim M et al7 studied the nutritional status and body mass index of pulmonary tuberculosis patients and found that mean BMI of pulmonary tuberculosis cases was (16.9 ± 1.1kg/m2). Natasha S. Hochberg et al8 found that 60.2% of tuberculosis patients were malnourished (body mass index [BMI] <18.5 kg/m2). We found 6 patients(2.4%) with isoniazid monoresistance and 9 patients (3.6%) with both isoniazid and rifampicin resistance (Figure 4). This results are comparable with Indian national figures of 2.84 % of primary MDR TB per PMDT guiselines 2017.9 While prevalence of isoniazid monoresistance was 11.6% in newly detected sputum smear positive patients as per 2017 PMDT guidelines, it was very low in our study(2.4%). This may be the result of timely diagnosis and treatment of tuberculosis and successful implementation of programme.

Source of funding

None.

Conflict of interest

None.