Background and Objective: Anti-tuberculosis drug resistance is a worldwide health concern with a higher burden in resource-limited countries and vulnerable individuals. This study aimed to compare epidemiology, biological characteristics, and treatment outcomes of primary and secondary MDR/RR-TB patients in the Republic of Togo. Materials and Methods: A retrospective cohort study was conducted from January 2016 to December 2021 at the DR-TB unit at the Department of Pulmonology of Sylvanus Olympio Teaching Hospital in Togo. Data were collected from the medical records of TB patients hospitalized for rifampicin resistance based on the Xpert/MTB/RIF？ results. A structured questionnaire was used to collect clinical, sociodemographic, biological, radiological, and patients’ outcomes data after the 9-month treatment regimen with the injectable TB drugs. Univariate and multivariate logistic regression analyses were performed to identify secondary MDR/RR associated factors. Results: A total of 89 patients, including 43 primary and 46 secondary MDR/RR-TB patient records, were enrolled in the final analysis. The sex ratio (male/female) was 1.3, and the mean age was 36.02 years. The secondary/acquired drug-resistant group was more likely to have dyspnea (aOR: 3.88, 95% CI: 1.01 - 14.38), nodules and infiltrates on chest-X-ray, respectively (aOR:3.62, 95% CI: 1.23 - 10.67) and (aOR: 4.66, 95% CI: 1.51 - 14.38). In addition, they were more likely to have a delay in MDR treatment initiation (aOR: 3.04, 95% CI: 1.08 - 8.58). Resistant to any first-line drugs was most found in the secondary drug-resistant group, while pre-XDR and XDR-TB were found in both groups. Conclusion: The secondary drug-resistant patients have the highest proportion of resistance patterns, including pre-XDR. Moreover, they are significantly associated with more lung lesions on chest X-ray. These results suggest a lack of treatment adherence and/or a high transmission rate of drug-resistant strains within the community. Hence, the importance of a non-pharmacological approach to improve adherence, contact tracking, and the improvement of laboratory capacities.
References
[1]
The WHO (2022) WHO Consolidated Guidelines on Tuberculosis. Module 4: Treatment-Drug-Resistant Tuberculosis Treatment, Update. World Health Organization. https://www.who.int/publications/i/item/9789240063129
[2]
The WHO (2023) Global Tuberculosis Report 2023. World Health Organization.
[3]
Litvinjenko, S., Magwood, O., Wu, S. and Wei, X. (2023) Burden of Tuberculosis among Vulnerable Populations Worldwide: An Overview of Systematic Reviews. TheLancetInfectiousDiseases, 23, 1395-1407. https://doi.org/10.1016/s1473-3099(23)00372-9
[4]
Adebisi, Y.A., Agumage, I., Sylvanus, T.D., Nawaila, I.J., Ekwere, W.A., Nasiru, M., et al. (2019) Burden of Tuberculosis and Challenges Facing Its Eradication in West Africa. InternationalJournalofInfection, 6, e92250. https://doi.org/10.5812/iji.92250
[5]
Otchere, I.D., Asante-Poku, A., Akpadja, K.F., Diallo, A.B., Sanou, A., Asare, P., et al. (2024) Opinion Review of Drug-Resistant Tuberculosis in West Africa: Tackling the Challenges for Effective Control. FrontiersinPublicHealth, 12, Article ID: 137470. https://doi.org/10.3389/fpubh.2024.1374703
[6]
Afanvi, K.A., Dogo, M.F., Aziagbé, K.A., Adjoh, K.S. and Ekouévi, K.K.D. (2023) Quality Mindset: The Missing Ingredient in Tuberculosis Care and Control in Togo. EuropeanJournalofTheoreticalandAppliedSciences, 1, 36-41. https://doi.org/10.59324/ejtas.2023.1(4).04
[7]
PNLT-Togo (2022) Guide national de prise en charge de la TB MR/RR. Ministere de la sante, PNLT, Première édition, 1-77.
[8]
Guillet-Caruba, C., Martinez, V. and Doucet-Populaire, F. (2014) Les nouveaux outils de diagnostic microbiologique de la tuberculose maladie. La Revue de Médecine Interne, 35, 794-800. https://doi.org/10.1016/j.revmed.2014.05.001
[9]
Villalva-Serra, K., Barreto-Duarte, B., Miguez-Pinto, J.P., Queiroz, A.T.L., Rodrigues, M.M., Rebeiro, P.F., et al. (2024) Impact of Xpert MTB/RIF Implementation in Tuberculosis Case Detection and Control in Brazil: A Nationwide Intervention Time-Series Analysis (2011-2022). TheLancetRegionalHealth-Americas, 36, Article ID: 100804. https://doi.org/10.1016/j.lana.2024.100804
[10]
Alexander, P.E. and De, P. (2007) The Emergence of Extensively Drug-Resistant Tuberculosis (TB): TB/HIV Coinfection, Multidrug-Resistant TB and the Resulting Public Health Threat from Extensively Drug-Resistant TB, Globally and in Canada. CanadianJournalofInfectiousDiseasesandMedicalMicrobiology, 18, 289-291. https://doi.org/10.1155/2007/986794
[11]
Faye, L., Hosu, M. and Apalata, T. (2024) Drug-Resistant Tuberculosis in Rural Eastern Cape, South Africa: A Study of Patients’ Characteristics in Selected Healthcare Facilities. International Journal of Environmental Research and Public Health, 21, Article No. 1594. https://doi.org/10.3390/ijerph21121594
[12]
de Dieu Longo, J., Woromogo, S.H., Tekpa, G., Diemer, H.S., Gando, H., Djidéré, F.A., et al. (2023) Risk Factors for Multidrug-Resistant Tuberculosis in the Central African Republic: A Case-Control Study. JournalofInfectionandPublicHealth, 16, 1341-1345. https://doi.org/10.1016/j.jiph.2023.06.007
[13]
Toft, A.L., Dahl, V.N., Sifna, A., Ige, O.M., Schwoebel, V., Souleymane, M.B., et al. (2022) Treatment Outcomes for Multidrug-and Rifampicin-Resistant Tuberculosis in Central and West Africa: A Systematic Review and Meta-Analysis. InternationalJournalofInfectiousDiseases, 124, S107-S116. https://doi.org/10.1016/j.ijid.2022.08.015
[14]
Tanimura, T., Jaramillo, E., Weil, D., Raviglione, M. and Lönnroth, K. (2014) Financial Burden for Tuberculosis Patients in Low-and Middle-Income Countries: A Systematic Review. EuropeanRespiratoryJournal, 43, 1763-1775. https://doi.org/10.1183/09031936.00193413
[15]
Menzies, N.A., Allwood, B.W., Dean, A.S., Dodd, P.J., Houben, R.M.G.J., James, L.P., et al. (2023) Global Burden of Disease Due to Rifampicin-Resistant Tuberculosis: A Mathematical Modeling Analysis. NatureCommunications, 14, Article No. 6182. https://doi.org/10.1038/s41467-023-41937-9
[16]
Dickson, L., Le Roux, S.R., Mitrani, L., Hill, J., Jassat, W., Cox, H., et al. (2023) Organisation of Care for People Receiving Drug-Resistant Tuberculosis Treatment in South Africa: A Mixed Methods Study. BMJOpen, 13, e067121. https://doi.org/10.1136/bmjopen-2022-067121
[17]
Mbuh, T.P., Mendjime, P., Goupeyou-Wandji, I., Donkeng-Donfack, V.F., Kahou, J., Endale Mangamba, L., et al. (2024) Trends of Drug-Resistant Tuberculosis and Risk Factors to Poor Treatment-Outcome: A Database Analysis in Littoral Region-Cameroon, 2013-2022. BMCPublicHealth, 24, Article No. 3195. https://doi.org/10.1186/s12889-024-20585-8
[18]
Farra, A., Danebera, L.V., Ngaya, G., Yambiyo, B.M., Manirakiza, A. and Mossoro-Kpinde, C.D. (2023) The Contribution of the Xpert® MTB/RIF Assay to the Surveillance of Drug-Resistant Tuberculosis in the Central African Republic. JournalofTuberculosisResearch, 11, 23-32. https://doi.org/10.4236/jtr.2023.111003
[19]
Biru, D. and Woldesemayat, E.M. (2020) Determinants of Drug-Resistant Tuberculosis in Southern Ethiopia: A Case-Control Study. InfectionandDrugResistance, 13, 1823-1829. https://doi.org/10.2147/idr.s256536
[20]
Yang, C., Luo, T., Shen, X., Wu, J., Gan, M., Xu, P., et al. (2017) Transmission of Multidrug-Resistant Mycobacterium Tuberculosis in Shanghai, China: A Retrospective Observational Study Using Whole-Genome Sequencing and Epidemiological Investigation. TheLancetInfectiousDiseases, 17, 275-284. https://doi.org/10.1016/s1473-3099(16)30418-2
[21]
Li, X., Zhang, Y., Shen, X., Shen, G., Gui, X., Sun, B., et al. (2007) Transmission of Drug-Resistant Tuberculosis among Treated Patients in Shanghai, China. The JournalofInfectiousDiseases, 195, 864-869. https://doi.org/10.1086/511985
[22]
Wáng, Y.X.J., Chung, M.J., Skrahin, A., Rosenthal, A., Gabrielian, A. and Tartakovsky, M. (2018) Radiological Signs Associated with Pulmonary Multi-Drug Resistant Tuberculosis: An Analysis of Published Evidences. QuantitativeImaginginMedicineandSurgery, 8, 161-173. https://doi.org/10.21037/qims.2018.03.06
[23]
Nofal, I.M.M., AbdelHalim, H.A., Almaraghy, A.A., Awad, A.M. and Farrag, M.A. (2024) Characteristics and Treatment Outcomes of Patients with Multi-Drug-Resistant Tuberculosis at Abbassia Chest Hospital. TheEgyptianJournalofBronchology, 18, 1-11. https://doi.org/10.1186/s43168-024-00348-0
[24]
Oladimeji, O., Adeniji-Sofoluwe, A.T., Othman, Y., Adepoju, V.A., Oladimeji, K.E., Atiba, B.P., et al. (2022) Chest X-Ray Features in Drug-Resistant Tuberculosis Patients in Nigeria; a Retrospective Record Review. Medicines, 9, Article No. 46. https://doi.org/10.3390/medicines9090046
[25]
Hamusse, S.D., Teshome, D., Hussen, M.S., Demissie, M. and Lindtjørn, B. (2016) Primary and Secondary Anti-Tuberculosis Drug Resistance in Hitossa District of Arsi Zone, Oromia Regional State, Central Ethiopia. BMCPublicHealth, 16, Article No. 593. https://doi.org/10.1186/s12889-016-3210-y
[26]
Eshetie, S., Gizachew, M., Dagnew, M., Kumera, G., Woldie, H., Ambaw, F., et al. (2017) Multidrug Resistant Tuberculosis in Ethiopian Settings and Its Association with Previous History of Anti-Tuberculosis Treatment: A Systematic Review and Meta-Analysis. BMCInfectiousDiseases, 17, Article No. 219. https://doi.org/10.1186/s12879-017-2323-y
[27]
Palomino, J. and Martin, A. (2014) Drug Resistance Mechanisms in Mycobacterium Tuberculosis. Antibiotics, 3, 317-340. https://doi.org/10.3390/antibiotics3030317
[28]
Loutet, M.G., Davidson, J.A., Brown, T., Dedicoat, M., Thomas, H.L. and Lalor, M.K. (2018) Acquired Resistance to Antituberculosis Drugs in England, Wales, and Northern Ireland, 2000-2015. EmergingInfectiousDiseases, 24, 524-533. https://doi.org/10.3201/eid2403.171362
[29]
O’Toole, R.F. (2022) Antibiotic Resistance Acquisition versus Primary Transmission in the Presentation of Extensively Drug-Resistant Tuberculosis. The International JournalofMycobacteriology, 11, 343-348. https://doi.org/10.4103/ijmy.ijmy_187_22
[30]
Ndjeka, N., Campbell, J.R., Meintjes, G., Maartens, G., Schaaf, H.S., Hughes, J., et al. (2022) Treatment Outcomes 24 Months after Initiating Short, All-Oral Bedaquiline-Containing or Injectable-Containing Rifampicin-Resistant Tuberculosis Treatment Regimens in South Africa: A Retrospective Cohort Study. TheLancetInfectiousDiseases, 22, 1042-1051. https://doi.org/10.1016/s1473-3099(21)00811-2
[31]
Bhering, M. and Kritski, A. (2020) Primary and Acquired Multidrug-Resistant Tuberculosis: Predictive Factors for Unfavorable Treatment Outcomes in Rio De Janeiro, 2000-2016. RevistaPanamericanadeSaludPública, 44, e178. https://doi.org/10.26633/rpsp.2020.178
[32]
The Global Fund (2020) Technical Brief Tuberculosis, Gender and Human Rights.
[33]
Ockenga, J., Fuhse, K., Chatterjee, S., Malykh, R., Rippin, H., Pirlich, M., et al. (2023) Tuberculosis and Malnutrition: The European Perspective. ClinicalNutrition, 42, 486-492. https://doi.org/10.1016/j.clnu.2023.01.016
