STUDY OF RESISTANCE TO FIRST-LINE DRUGS IN MULTIDRUG RESISTANCE TUBERCULOSIS SUSPECTS FROM SPUTUM SAMPLES BY GOLD STANDARD – STANDARD ECONOMIC VARIANT 1% PROPORTION METHOD IN NORTH COASTAL ANDHRA PRADESH

Nitin Mohan; Indugula Jyothi Padmaja; Ratna Harika Dusi; Kancharla Suresh

doi:10.22159/ajpcr.2022.v15i10.45521

Authors

Nitin Mohan Department of Microbiology, GITAM Institute of Medical Sciences and Research, GITAM Deemed to be University, Visakhapatnam, Andhra Pradesh, India.
Indugula Jyothi Padmaja Department of Microbiology, GITAM Institute of Medical Sciences and Research, GITAM Deemed to be University, Visakhapatnam, Andhra Pradesh, India.
Ratna Harika Dusi Department of Microbiology, GITAM Institute of Medical Sciences and Research, GITAM Deemed to be University, Visakhapatnam, Andhra Pradesh, India.
Kancharla Suresh Department of Microbiology, GITAM Institute of Science, GITAM Deemed to be University, Visakhapatnam, Andhra Pradesh, India.

DOI:

https://doi.org/10.22159/ajpcr.2022.v15i10.45521

Keywords:

Mycobacterium tuberculosis, Drug resistance, Multidrug resistance-tuberculosis, First-line drugs

Abstract

Objectives: The objectives of the study were to culture Mycobacterium tuberculosis from sputum samples of multidrug resistance (MDR) suspects on Lowenstein-Jensen (LJ) media, to test for susceptibility and resistance to first-line antitubercular drugs rifampicin (RMP), isoniazid (INH), streptomycin (SM), and ethambutol (EMB) by conventional DST on LJ media by standard economic variant proportion (1%) method and to calculate the rate of MDR and pattern of drug resistance in MDR tuberculosis (MDR-TB) suspects.

Methods: A prospective, laboratory-based study was done on a total of 80 samples from cases of suspected pulmonary and extra-pulmonary TB. Identification of culture isolates as M. tuberculosis was done by susceptibility to p-nitrobenzoic acid (PNB), niacin test, and catalase activity at 68°C/pH 7. Drug sensitivity testing (DST) of M. tuberculosis cultures on LJ medium for drugs was performed by a standard economic variant of the 1% proportion method.

Results: Among MDR suspects, the maximum is in the age group of 45–60 years (35%) with a mean age of 42.75±15.93 years. The sex ratio of male to female is 2:1. Out of 80 samples, 36 samples (45%) were graded 1+, 31 samples (38.7%) 2+, and 13 samples (16.3%) 3+. All 80 sputum samples showed growth on LJ media within 8 weeks. When colonies obtained on LJ medium were subjected to biochemical tests for identification, all were positive for M. tuberculosis. Out of 80 M. tuberculosis isolates tested for sensitivity against first-line drugs (except pyrazinamide), 45 (56.3%) were found to be sensitive to all four drugs (INH, RMP, EMB, and SM), and 35 (43.7%) were resistant to at least one drug. Nine isolates (11.3%) showed resistance to a single drug (monoresistance). The various MDR patterns were INH+RMP seen in 6 strains (7.5%) and INH+RMP+SM seen in 4 strains (5%).

Conclusion: Drug resistance trends must be closely monitored to evaluate the efficiency of existing therapies and their effect on pulmonary tuberculosis epidemic. To design the new drug regulations, more extensive data on drug sensitivity with standardized testing protocols which is quality assured are required.

Downloads

Download data is not yet available.

References

Fodor T, Vadász I, Lõrinczi I. Drug-resistant tuberculosis in Budapest. Int J Tuberc Lung Dis 1998;2:732-5. PMID 9755927

Indian Council of Medical Research. Standard Operating Procedure for Mycobacteriology Laboratory. Chennai: Tuberculosis Research Centre, Indian Council of Medical Research; 2010.

Vijay S, Balasangameshwara VH, Jagannatha PS, Saroja VN, Shivashankar D, Jagota P. Re-treatment outcome of smear positive tuberculosis cases under DOTS in Bangalore City. Ind J Tub 2002;49:195.

Bhatt G, Vyas S, Trivedil K. An epidemiological study of multi drug resistant tuberculosis cases registered under Revised National Tuberculosis Control Programme of Ahmedabad City. Indian J Tuberc

;59:18-27. PMID 22670507

Bazira J, Asiimwe BB, Joloba ML, Bwanga F, Matee MI. Use the Genotype(R) MTBDRplus assay to assess drug resistance of Mycobacterium tuberculosis isolates from patients in rural Uganda. BMC Clin Pathol 2010;10:5.

Raveendran R, Wattal C, Oberoi JK, Goel N, Datta S, Prasad KJ. Utility of Genotype MTBDRplus assay in rapid diagnosis of multidrug resistant tuberculosis at a tertiary care center in India. Indian J Med Microbiol 2012;30:58-63. doi: 10. 4103/0255-0857. 93034, PMID 22361762

Huyen MN, Tiemersma EW, Lan NT, Cobelens FG, Dung NH, Sy DN, et al. Validation of the GenoType MTBDRplus assay for diagnosing multidrug resistant tuberculosis in South Vietnam. BMC Infect Dis 2010;10:149. doi: 10. 1186/1471-2334-10-149, PMID 20525271, PMCID PMC2901356

Rai SP, Panda BN, Pahwa RS, Jena J, Rajan KE. Pattern of drug resistance in relapsing cases of pulmonary tuberculosis after short-course chemotherapy. Lung India 1995;13:100-2.

Rawat J, Sindhwani G, Juyal R, Dua R. Five-year trend of acquired antitubercular drug resistance in patients attending a tertiary care hospital at Dehradun (Uttarakhand). Lung India 2009;26:106-8. doi: 10. 4103/0970-2113. 56342, PMID 20531990

Vasanthakumari R, Jagannath K. Multidrug-resistant tuberculosis-a Tamil Nadu study. Lung India 1997;15:178-80.

Polu GP, Shaik JM, Kota NM, Karumanchi D, Allam US. Analysis of drug resistance mutations in pulmonary Mycobacterium tuberculosis isolates in the Southern coastal region of Andhra Pradesh, India. Braz J Infect Dis 2019;23:281-90. doi: 10. 1016/j. bjid. 2019. 07. 002

Sharma SK, Kumar S, Saha PK, George N, Arora SK, Gupta D, et al. Prevalence of multidrug-resistant tuberculosis among Category II pulmonary tuberculosis patients. Indian J Med Res 2011;133:312-5. PMID 21441686

Menon S, Dharmshale S, Chande C, Gohil A, Lilani S, Mohammad S, et al. Drug resistance profiles of Mycobacterium tuberculosis isolates to first line anti-tuberculous drugs: A five years study. Lung India 2012;29:227-31. doi: 10. 4103/0970-2113. 99104, PMID 22919160