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First Nationwide Survey of the Prevalence of TB/HIV Co-Infection in Ghana  [PDF]
Kennedy K. Addo, William K. Ampofo, Richard Owusu, Christian Bonsu, Naomi Nartey, Gloria I. Mensah, Samuel O. Addo, Kofi Bonney, Justice Kumi, Adukwei Hesse, Nii A. Addo, Frank A. Bonsu
Journal of Tuberculosis Research (JTR) , 2018, DOI: 10.4236/jtr.2018.62013
Abstract: Background: To better understand the extent of the magnitude of tuberculosis (TB) and Human Immunodeficiency Virus (HIV) co-infection in Ghana, a baseline study was conducted to establish the national prevalence of the dual infection. The study aimed to determine the most prevalent HIV serotype (HIV-1 or HIV-2) in TB patients (new and old cases); genotype mycobacterial species causing TB/HIV co-infection and determine their drug susceptibility patterns. Methods: Sputum and dried blood samples were collected from 503 TB patients from 67 health facilities nationwide between December 2007 and November 2008. All samples were processed for mycobacterial and HIV testing using conventional and molecular methods. Results: A total of 517 paired sputum samples were received from 517 patients. A total 503 patients [335 (66.6%) males; 168 (33.4%) females] had at least one culture positive sample. Majority (93.0%) of the patients were new cases while 7.0% were old cases. All 503 TB isolates were Mycobacterium tuberculosis complex. Of 503 blood samples, 74 were positive for HIV (14.7%), comprising 71 (14.1%) and 3 (0.6%) for HIV-1 and HIV-1 & 2 respectively; none was positive for HIV-2 alone. The seroprevalence of HIV in newly diagnosed TB patients and those already on treatment, was 69/468 (14.7%) and 5/35 (14.3%) respectively (p > 0.05). Differentiation of isolates from TB/HIV co-infected patients showed that 70/74 (94.6%) were Mycobacterium tuberculosis while 4/74 (5.4%) were Mycobacterium africanum. Monoresistance to isoniazid and rifampicin were 4/74 (5.4%) and 1/74 (1.4%) respectively; resistance to both drugs (multi-drug resistant-MDR) was not observed. Sixty nine (93.2%) isolates were susceptible to both drugs. Conclusion: The prevalence of HIV infection in TB patients was 14.7%. TB/HIV was common among the sexually active age group (25 - 34 years). Majority of the TB isolates were M. tuberculosis which were susceptible to both isoniazid and rifampicin. HIV-1 was the common serotype infecting TB patients in Ghana.
First Line Anti-Tuberculosis Drugs Resistance Patterns of Mycobacterium tuberculosis Isolates from Newly Diagnosed Cases of Tuberculosis  [PDF]
Yogita Mistry, Sangita Rajdev, Summaiya Mullan
Open Journal of Medical Microbiology (OJMM) , 2017, DOI: 10.4236/ojmm.2017.73006
Abstract: Introduction: Tuberculosis is a major cause of mortality and morbidity world-wide. Anti-tuberculosis drugs have been used for many decades but resistance to them is now widespread. Globally 5% of tuberculosis cases and in India 3% among new TB cases. This study was planned to know the pattern of first line anti-tuberculosis drug resistance in south Gujarat, Surat region in newly diagnosed patients of tuberculosis. Material and Methods: 350 samples were processed for homogenisation and concentration using 4% NAOH-2.9% trisodium citrate. Processed samples were inoculated in liquid medium that is MGIT (Mycobacterial growth indicator tube). Positive samples for M. tbwere processed further for first line anti-tuberculosis drugs sensitivity testing (DST). Reading was taken by using MicroMGIT system. Result: Out of 350 samples 59 (17%) were positive samples, of which 48 (13%) were M. tb and 11 (3%) were non tuberculous mycobacteria. Out of 48 samples 2% (1 isolate) was resistant to isoniazid and Rifampicin while 2% were monoresistant to isoniazide, 2% monoresistant to streptomycin. No rifampicin monoresistant was detected. Conclusion: Such study may help in control of tuberculosis at regional and national level which would in turn help in planning of measures to control Multi-drug resistance tuberculosis. Continuous surveillance should be applied to know the periodic changing patterns and trend in Drug resistant tuberculosis.
Resistance to First-Line Anti-TB Drugs Is Associated with Reduced Nitric Oxide Susceptibility in Mycobacterium tuberculosis  [PDF]
Jonna Idh, Mekidim Mekonnen, Ebba Abate, Wassihun Wedajo, Jim Werngren, Kristian ?ngeby, Maria Lerm, Daniel Elias, Tommy Sundqvist, Abraham Aseffa, Olle Stendahl, Thomas Sch?n
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0039891
Abstract: Background and Objective The relative contribution of nitric oxide (NO) to the killing of Mycobacterium tuberculosis in human tuberculosis (TB) is controversial, although this has been firmly established in rodents. Studies have demonstrated that clinical strains of M. tuberculosis differ in susceptibility to NO, but how this correlates to drug susceptibility and clinical outcome is not known. Methods In this study, 50 sputum smear- and culture-positive patients with pulmonary TB in Gondar, Ethiopia were included. Clinical parameters were recorded and drug susceptibility profile and spoligotyping patterns were investigated. NO susceptibility was studied by exposing the strains to the NO donor DETA/NO. Results Clinical isolates of M. tuberculosis showed a dose- and time-dependent response when exposed to NO. The most frequent spoligotypes found were CAS1-Delhi and T3_ETH in a total of nine known spoligotypes and four orphan patterns. There was a significant association between reduced susceptibility to NO (>10% survival after exposure to 1 mM DETA/NO) and resistance against first-line anti-TB drugs, in particular isoniazid (INH). Patients infected with strains of M. tuberculosis with reduced susceptibility to NO showed no difference in cure rate or other clinical parameters but a tendency towards lower rate of weight gain after two months of treatment, independent of antibiotic resistance. Conclusion: There is a correlation between resistance to first-line anti-TB drugs and reduced NO susceptibility in clinical strains of M. tuberculosis. Further studies including the mechanisms of reduced NO susceptibility are warranted and could identify targets for new therapeutic interventions.
Comparative evaluation of the Nitrate Reductase Assay and the Resazurin Microtitre Assay for drug susceptibility testing of Mycobacterium tuberculosis against first line anti-tuberculosis drugs
Sanchotene, Karine O.;von Groll, Andrea;Ramos, Daniela;Scholante, Ana B.;Honscha, Gunther;Valen?a, Mariana;Scaini, Carlos J.;Silva, Pedro E.A. da;
Brazilian Journal of Microbiology , 2008, DOI: 10.1590/S1517-83822008000100004
Abstract: tuberculosis remains as a serious infection disease of worldwide distribution, with high morbidity and mortality, mainly in low socio-economic condition countries. the state of emergency of tuberculosis caused by the resistant and multidrug-resistant (mdr) strains, became the main threat to the tuberculosis treatment and control programs. a fast detection method for the resistant strains will allow the implementation of an adequate treatment and contribute for controlling the dissemination of these resistant strains. this study evaluated the performance of the nitrate reductase assay in solid (nra-lj) and liquid (nra-7h9) media, to determine the susceptibility to first line anti-tuberculosis drugs: isoniazid (inh), rifampicin (rmp), ethambutol (emb) and streptomycin (smr). both methods nra-lj and nra-7h9 were evaluated among 18 strains with a known susceptibility profile. the resazurin microtiter assay (rema) was performed as a reference method. one hundred percent of accordance was observed between nra-7h9 and rema for the four tested drugs. when the nra-lj method was compared to rema, the sensitivity and the specificity to inh, rmp, emb and smr were 100%, 100 %, 85.7%, 76.9% and 80%, 100%, 75% and 80%, respectively. from the 57 clinical isolates of m. tuberculosis evaluated by nra-7h9 and rema, 56 (98.2%) were sensitive to all antibiotics tested (inh, rmp, emb and smr) by the nra-7h9 method, while three of these strains were resistant to inh by rema. one strain showed resistance to inh and rmp for both methods, and mic of 1.0 μg/ml to inh for both methods, while mic of 1.0 and 2.0 μg/ml to rmp for rema and nra-7h9, respectively. the three assays showed a high level of agreement for rapid detection of rifampicin and isoniazid resistance. regarding rapidness, the detection of color change in the nra method is within instants as compared to the overnight incubation required for the rema test. nra might represent an inexpensive and alternative assay for rapid detectio
Previous use of quinolones: a surrogate marker for first line anti-tuberculosis drugs resistance in HIV-infected patients?
Deutschendorf, Caroline;Goldani, Luciano Z.;Santos, Rodrigo Pires dos;
Brazilian Journal of Infectious Diseases , 2012, DOI: 10.1590/S1413-86702012000200006
Abstract: objectives: drug resistant mycobacterium tuberculosis causes much higher rates of treatment toxicity, failure or relapse, and mortality. we determined the drug resistant profile of mycobacterium tuberculosis strains isolated from a population of hiv-infected patients in southern brazil and studied the potential factors associated with resistance. methods: we conducted a retrospective cohort study to determine the resistance profile of mycobacterium tuberculosis isolated from hiv-infected patients and factors that could be associated with resistance from 2000 to 2005. results: 236 patients were included in the study. resistance to at least one drug was observed in 32 (14.6%) isolates, and multi-drug resistance was observed in 4 (1.82%) isolates. on multivariate analysis, previous use of tuberculostatics and quinolones were related to any first-line drug resistance. conclusions: in our study, previous quinolone use was significantly associated to first-line anti-tb drugs resistance. multi-drug-resistant tuberculosis (mdr-tb) is a major problem worldwide, and we believe quinolones should be used with caution in settings where tb is endemic.
Evaluation of indirect susceptibility testing of Mycobacterium tuberculosis to the first- and second-line, and alternative drugs by the newer MB/BacT system
Barreto, Angela Maria Werneck;Araújo, Joselba Borges Melo;Medeiros, Reginalda Ferreira de Melo;Caldas, Paulo César de Souza;
Memórias do Instituto Oswaldo Cruz , 2003, DOI: 10.1590/S0074-02762003000600020
Abstract: in order to evaluate the organon teknika mb/bact system used for testing indirect susceptibility to the alternative drugs ofloxacin (oflo), amikacin (ami), and rifabutin (rif), and to the usual drugs of standard treatment regimes such as rifampin (rmp), isoniazid (inh), pyrazinamide (pza), streptomycin (sm), ethambutol (emb), and ethionamide (eth), cultures of clinical specimens from 117 patients with pulmonary tuberculosis under multidrug-resistant investigation, admitted sequentially for examination from 2001 to 2002, were studied. fifty of the mycobacterium tuberculosis cultures were inoculated into the gold-standard bactec 460 tb (becton dickinson) for studying resistance to ami, rif, and oflo, and the remaining 67 were inoculated into lowenstein jensen (lj) medium (the gold standard currently used in brazil) for studying resistance to rmp, inh, pza, sm, emb, and eth. we observed 100% sensitivity for ami (80.8-100), rif (80.8-100), and oflo (78.1-100); and 100% specificity for ami (85.4-100), rif (85.4-100), and oflo (86.7-100) compared to the bactec system. comparing the results obtained in lj we observed 100% sensitivity for rmp (80-100), followed by inh - 95% (81.8-99.1), emb - 94.7% (71.9-99.7), and 100% specificity for all drugs tested except for pza - 98.3 (89.5-99.9) at 95% confidence interval. the results showed a high level of accuracy and demonstrated that the fully automated, non-radiometric mb/bact system is indicated for routine use in susceptibility testing in public health laboratories.
Evaluation of indirect susceptibility testing of Mycobacterium tuberculosis to the first- and second-line, and alternative drugs by the newer MB/BacT system  [cached]
Barreto Angela Maria Werneck,Araújo Joselba Borges Melo,Medeiros Reginalda Ferreira de Melo,Caldas Paulo César de Souza
Memórias do Instituto Oswaldo Cruz , 2003,
Abstract: In order to evaluate the Organon Teknika MB/BacT system used for testing indirect susceptibility to the alternative drugs ofloxacin (OFLO), amikacin (AMI), and rifabutin (RIF), and to the usual drugs of standard treatment regimes such as rifampin (RMP), isoniazid (INH), pyrazinamide (PZA), streptomycin (SM), ethambutol (EMB), and ethionamide (ETH), cultures of clinical specimens from 117 patients with pulmonary tuberculosis under multidrug-resistant investigation, admitted sequentially for examination from 2001 to 2002, were studied. Fifty of the Mycobacterium tuberculosis cultures were inoculated into the gold-standard BACTEC 460 TB (Becton Dickinson) for studying resistance to AMI, RIF, and OFLO, and the remaining 67 were inoculated into Lowenstein Jensen (LJ) medium (the gold standard currently used in Brazil) for studying resistance to RMP, INH, PZA, SM, EMB, and ETH. We observed 100% sensitivity for AMI (80.8-100), RIF (80.8-100), and OFLO (78.1-100); and 100% specificity for AMI (85.4-100), RIF (85.4-100), and OFLO (86.7-100) compared to the BACTEC system. Comparing the results obtained in LJ we observed 100% sensitivity for RMP (80-100), followed by INH - 95% (81.8-99.1), EMB - 94.7% (71.9-99.7), and 100% specificity for all drugs tested except for PZA - 98.3 (89.5-99.9) at 95% confidence interval. The results showed a high level of accuracy and demonstrated that the fully automated, non-radiometric MB/BacT system is indicated for routine use in susceptibility testing in public health laboratories.
Resistance of mycobacterium tuberculosis to the first line anti tubercular drugs - A twenty year review  [cached]
Jesudason M,Mukundan U,Saaya R,Vanitha K
Indian Journal of Medical Microbiology , 2003,
Abstract: Tuberculosis and more so the multi drug resistant variety has been thrust into the forefront as a serious and life threatening illness in recent years. The advent of AIDS contributes to this substantially, especially in the developed world where it had become practically non- existent. We reviewed our data over the past 20 years with a view to determine when drug resistance began to manifest in the strains.
Use of Cost Effective Semi-Automated (Mannual/Micro) MGIT System over BACTEC 960 to Perform First Line Anti-Tuberculosis Drugs Sensitivity Testing  [PDF]
Yogita Mistry, Sangita Rajdev, Summaiya Mullan
Journal of Tuberculosis Research (JTR) , 2016, DOI: 10.4236/jtr.2016.44025
Abstract: Introduction: Multi-drug resistant tuberculosis (MDR-TB) that is the tuberculosis that is resistant to at least 2 of the first line anti-tuberculosis drugs is fatal infectious disease. Cases of MDR-TB are now increasing with 30,000 cases of MDR-TB reported in 2013 by national TB programme. Rapid diagnosis of MDR-TB is extremely important for rapid treatment of patient and to prevent spread of MDR-TB to other. BACTEC 960 system helps in rapid diagnosis but purchase of expensive instrument for the same is the limitation. However, the same purpose can be solved by use of semi-automated MGIT system. Aims and Objectives: Aim of this study is to do drug sensitivity testing of the first line anti-tuberculosis drugs with the use of semi-automated MGIT systems. 350 newly registered and suspected cases of tuberculosis in tertiary care hospital were included. Samples were processed for digestion and decontamination and inoculated in MGIT tubes and also on LJ medium. Reading was taken using semi-automated MGIT system. Positive tubes were confirmed by rapid test for M. tuberculosis and then drug sensitivity was performed. Result: Out of 350 samples, 62% were sputum; 33% were pleural fluid and rest 5% were lymph node, Ascetic fluid, CSF, pus. Average day of positivity by MGIT was 13 - 20 days as compared to 25 - 37 days by solid medium, which was statistically significant with p value < 0.01. MDR cases were 2% out of 350 samples. Conclusion: Manual MGIT System is a simple, efficient, safe to use diagnostic system. It does not require any expensive/special instrumentation other than the UV lamp for detection of fluorescence. The rapidity by which mycobacteria are detected is the most important advantage of the Manual MGIT. In areas with limited resources where purchase of expensive instruments such as the MGIT960 is out of scope, the use of manual MGIT for rapid susceptibility testing for MDR-TB could be a possibility.
Resistance to antimicrobial drugs in Ghana
Newman MJ, Frimpong E, Donkor ES, Opintan JA, Asamoah-Adu A
Infection and Drug Resistance , 2011, DOI: http://dx.doi.org/10.2147/IDR.S21769
Abstract: istance to antimicrobial drugs in Ghana Original Research (2588) Total Article Views Authors: Newman MJ, Frimpong E, Donkor ES, Opintan JA, Asamoah-Adu A Published Date December 2011 Volume 2011:4 Pages 215 - 220 DOI: http://dx.doi.org/10.2147/IDR.S21769 Mercy J Newman1, Enoch Frimpong2, Eric S Donkor1, Japheth A Opintan1, Alex Asamoah-Adu3 1Department of Microbiology, University of Ghana Medical School, Accra, Ghana, 2School of Medical Sciences, Kwame Nkrumah University of Science and Technology, 3Public Health Reference Laboratory, Korle-Bu, Accra, Ghana Background: Antimicrobial drug resistance is a global issue that affects health, economic, and social development. The problem has been attributed to misuse of antimicrobial agents. Purpose: To identify the agents of bacterial infection in Ghana, determine their antibiogram, and the possibility of setting up a surveillance program. Patients and methods: A prospective quantitative study set in various hospitals including two teaching hospitals, seven regional hospitals, and two district hospitals in Ghana. A total of 5099 bacterial isolates from various clinical specimens were collected over a period of 1 year, including data related to the patients. Susceptibility of the isolates was determined by the Kirby–Bauer method. In addition, the minimum inhibitory concentration (MIC) of multidrug-resistant isolates of epidemiological significance was also determined using the E-test. Results: A wide range of bacterial isolates were identified in both teaching and regional hospitals. High percentage of resistance was observed for tetracycline (82%), cotrimoxazole (73%), ampicillin (76%), and chloramphenicol (75%). Multidrug resistance was observed to a combination of ampicillin, tetracycline, chloramphenicol, and cotrimoxazole. On the other hand, a lower percentage of resistance was observed for ceftriaxone (6.3%), ciprofloxacin (11%), and amikacin (9.9%). Conclusion: Generally, the prevalence of multidrug resistance was widespread among the various isolates. Some multidrug-resistant strains of Staphylococcus aureus, Salmonella typhi, and non-typhoidal Salmonella (NTS) had high MIC to cefuroxime (>256), gentamicin (>256), and ciprofloxacin (>32).
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