Deivanayagam C N, Rajasekaran S, Venkatesan R, Mahilmaran A, Ahmed P R Khaiser, Annadurai S, Kumar S, Chandrasekar C, Ravichandran N, Pencillaiah R
Government Hospital of Thoracic Medicine, Tambaram Sanatorium, Chennai.
Indian J Chest Dis Allied Sci. 2002 Oct-Dec;44(4):237-42.
Mounting prevalence of primary and acquired multidrug-resistant tuberculosis in India is a sorry reminder of all round failure in our fight against tuberculosis and also of the necessity for new effective strategies.
(1) To assess the prevalence and pattern of drug resistant pulmonary tuberculosis among treated patients or on those on treatment without adequate response and (2) to evaluate HIV seropositivity among MDR-TB patients.
Pulmonary TB patients, who had at least six months of unsuccessful anti-tuberculous treatment were selected for the study. Their sputum specimens were examined for M. tuberculosis culture and drug sensitivity pattern and serological examinations for HIV infection were carried out.
Sputum specimens of 618 patients' (61.8%) of a total of 1000 examined had shown culturable M. tuberculosis. Four hundred ninty-five patients (49.5%) were found to expectorate tubercle bacilli resistant to one or more anti TB drugs. MDR-TB was detected in 339 patients (33.9%). HIV seropositivity among MDR-TB was 4.42%. Significantly, 245 patients (24.5%) had tubercle bacilli resistant to one or more reserve drugs too (ethionamide, kanamycin and/or ofloxacin).
Prevalence of MDR-TB was high in the study population. It is essentially an acquired condition. Its association with HIV disease was at present on the lower side, an observation contrary to published western literature. Higher rates of resistance for reserve drugs (ethionamide, kanamycin and/or ofloxacin) in patients who never had these drugs in their earlier treatment schedules suggest the possibility of emerging spontaneous drug resistant mutants.
印度原发性和获得性耐多药结核病的患病率不断上升，这令人遗憾地提醒我们，在抗击结核病的斗争中全面失败，也凸显了采取新的有效策略的必要性。
（1）评估接受治疗但反应不佳或正在接受治疗的患者中耐药性肺结核的患病率和模式；（2）评估耐多药结核病患者中的HIV血清阳性率。
选择至少接受了六个月抗结核治疗但未成功的肺结核患者进行研究。对他们的痰标本进行结核分枝杆菌培养和药敏模式检查，并进行HIV感染的血清学检查。
在总共1000份检查的痰标本中，有618例患者（61.8%）的标本显示可培养的结核分枝杆菌。发现495例患者（49.5%）咳出对一种或多种抗结核药物耐药的结核杆菌。在339例患者（33.9%）中检测到耐多药结核病。耐多药结核病患者中的HIV血清阳性率为4.42%。值得注意的是，245例患者（24.5%）的结核杆菌对一种或多种二线药物（乙硫异烟胺、卡那霉素和/或氧氟沙星）也耐药。
研究人群中耐多药结核病的患病率很高。这基本上是一种后天获得的疾病。目前其与HIV疾病的关联较低，这一观察结果与已发表的西方文献相反。在早期治疗方案中从未使用过这些药物的患者中，二线药物（乙硫异烟胺、卡那霉素和/或氧氟沙星）的耐药率较高，这表明可能出现了自发的耐药突变体。
