Biadglegne Fantahun, Tessema Belay, Sack Ulrich, Rodloff Arne C
College of Medicine & Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia; Institute of Medical Microbiology & Epidemiology of Infectious Diseases; Institute of Clinical Immunology, University Hospital; Translational Centre for Regenerative Medicine (TRM)-Leipzig, University of Leipzig, Leipzig, Germany, .
Indian J Med Res. 2014 Jul;140(1):116-22.
BACKGROUND & OBJECTIVES: The emergence of drug resistance tuberculosis (TB) is a significant challenge for TB control and prevention programmes, and the major problem is multidrug resistant tuberculosis (MDR-TB). The present study was carried out to determine the frequency of drug resistant Mycobacterium tuberculosis isolates among newly and retreated TB lymphadenitis patients and risk factors for acquiring this infection.
Two hundred twenty five M. tuberculosis isolates from TB lymphadenitis patients who were diagnosed as new and retreated tuberculosis cases between April 2012 and May 2012 were included in this study. Isolates were tested for susceptibility to isoniazed (INH), rifampicin (RMP), streptomycin (SM), ethambutol (EMB) and pyrazinamide (PZA) using the BacT/AlerT 3D system protocol.
Among 225 isolates, 15 (6.7%) were resistant to at least one first line anti-TB drug. Three (1.3%) were MDR-TB. Resistance to INH, RMP, SM, and EMB was found in 8 (3.6%), 4 (1.8%), 10 (4.4%), and 4 (1.8%) isolates, respectively. Of the 212 new TB lymphadenitis cases three (1.4%) were MDR-TB. A rifampicin resistant M. tuberculosis isolate was diagnosed from smear and culture negative newly treated cases. All isolates were susceptible to PZA. Matted cervical lymph nodes were the prominent sites involved. Newly treated TB lymphadenitis patients had a greater risk for presenting resistance to anti-TB drugs ( p =0.046).
INTERPRETATION & CONCLUSIONS: Our study showed that TB lymphadenitis patients harboured drug resistant TB and MDR-TB, although at a low rate. Resistance was not associated with age, sex, patients' education and contact history. Further research is required to determine transmission dynamics of drug resistant strains.
耐药结核病的出现是结核病防控项目面临的重大挑战，主要问题是耐多药结核病（MDR-TB）。本研究旨在确定新发病例和复治结核性淋巴结炎患者中结核分枝杆菌耐药菌株的频率以及获得该感染的危险因素。
本研究纳入了2012年4月至2012年5月期间诊断为新发病例和复治病例的225株结核性淋巴结炎患者的结核分枝杆菌分离株。使用BacT/AlerT 3D系统方案检测分离株对异烟肼（INH）、利福平（RMP）、链霉素（SM）、乙胺丁醇（EMB）和吡嗪酰胺（PZA）的敏感性。
在225株分离株中，15株（6.7%）对至少一种一线抗结核药物耐药。3株（1.3%）为耐多药结核病。分别在8株（3.6%）、4株（1.8%）、10株（4.4%）和4株（1.8%）分离株中发现对INH、RMP、SM和EMB耐药。在212例新结核性淋巴结炎病例中，3例（1.4%）为耐多药结核病。从涂片和培养均为阴性的新治疗病例中诊断出一株利福平耐药结核分枝杆菌分离株。所有分离株对PZA敏感。颈部淋巴结融合是主要受累部位。新治疗的结核性淋巴结炎患者出现抗结核药物耐药的风险更高（p = 0.046）。
我们的研究表明，结核性淋巴结炎患者携带耐药结核病和耐多药结核病，尽管比例较低。耐药与年龄、性别、患者教育程度和接触史无关。需要进一步研究以确定耐药菌株的传播动态。
