Vidyaraj C K, Chitra A, Smita S, Muthuraj M, Govindarajan S, Usharani B, Anbazhagi S
State TB Training and Demonstration Centre, Intermediate Reference Laboratory, Government Hospital for Chest Diseases, Puducherry, India.
State TB Training and Demonstration Centre, Intermediate Reference Laboratory, Government Hospital for Chest Diseases, Puducherry, India.
J Epidemiol Glob Health. 2017 Dec;7(4):289-294. doi: 10.1016/j.jegh.2017.09.002. Epub 2017 Sep 21.
Multidrug resistant (MDR) and extensively drug resistant tuberculosis (TB) are a threat to the TB control programs in developing countries, and the situation is worsened by the human immunodeficiency virus (HIV) pandemic. This study was performed to correlate treatment outcome with the resistance patterns in HIV-seropositive patients coinfected with pulmonary TB. Sputum specimens were collected from 1643 HIV-seropositive patients and subjected to microscopy and liquid culture for TB. The smear- and culture-positive Mycobacterium tuberculosis isolates were subjected to Genotype MTBDRplus assay version 2.0. The M. tuberculosis culture-positivity rate was 39.44% (648/1643) among the 1643 HIV-seropositive patients and the overall MDR-TB rate was 5.6% (36/648). There were 421 newly diagnosed and 227 previously treated patients, among whom, MDR-TB was associated with 2.9% and 10.57% cases, respectively. The rate of rifampicin monoresistant TB among the cases of MDR-TB was 2.31% (15/648) and the rate of combined rifampicin and isoniazid resistance was 3.24% (21/648). The cure and death rates among the 20 registered cases were 30% (6/20) and 35% (7/20), respectively. Five cases were on treatment and two cases were defaulters among the 20 registered cases. High death rate (13, 36.1%, 95% confidence interval 20.8-53.8) was observed in this study among the patients who had mutations at the 530-533 codons. The present study emphasized the prerequisite to monitor the trend of drug-resistant TB in various mutant populations in order to timely implement appropriate interventions to curb the threat of MDR-TB.
耐多药（MDR）和广泛耐药结核病（TB）对发展中国家的结核病控制项目构成威胁，而人类免疫缺陷病毒（HIV）大流行使情况更加恶化。本研究旨在将治疗结果与合并肺结核的HIV血清阳性患者的耐药模式相关联。从1643例HIV血清阳性患者中收集痰标本，并进行结核分枝杆菌的显微镜检查和液体培养。对涂片和培养阳性的结核分枝杆菌分离株进行Genotype MTBDRplus 2.0版检测。在1643例HIV血清阳性患者中，结核分枝杆菌培养阳性率为39.44%（648/1643），总体耐多药结核病率为5.6%（36/648）。有421例新诊断患者和227例既往治疗患者，其中耐多药结核病分别占2.9%和10.57%。耐多药结核病病例中利福平单耐药结核病率为2.31%（15/648），利福平和异烟肼联合耐药率为3.24%（21/648）。20例登记病例中的治愈和死亡率分别为30%（6/20）和35%（7/20）。20例登记病例中有5例正在治疗，2例失访。本研究中观察到，在第530 - 533密码子发生突变的患者中死亡率较高（13例，36.1%，95%置信区间20.8 - 53.8）。本研究强调了监测不同突变人群中耐药结核病趋势的必要性，以便及时实施适当干预措施，遏制耐多药结核病的威胁。
