Atnafu Abay, Wassie Liya, Tilahun Melaku, Girma Selfu, Zenebe Yohannes, Beyene Muluye Abebe, Alemu Ashenafi, Fisseha Emnet, Agze Haymanot, Desta Tigist, Desta Kassu, Bobosha Kidist
Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Infect Drug Resist. 2023 Jun 1;16:3453-3461. doi: 10.2147/IDR.S407866. eCollection 2023.
Extrapulmonary tuberculosis (EPTB), particularly tubercular lymphadenitis (TBLN), remains to pose a huge public health problem in Ethiopia. A significant number of TBLN patients who completed a full course anti-TB treatment regimen were reported to have enlarged lymph nodes and other TB-like clinical presentations. This could either be from a paradoxical reaction or microbiological relapse, possibly due to mono/multi-drug resistance.
To investigate the rate of mono and multidrug resistance patterns of as a cause of the observed treatment failures in clinically diagnosed and anti-TB treatment (newly or previously)-initiated LN patients.
A cross-sectional study was conducted on 126 TBLN-suspected and previously treated patients between March and September 2022. Data were analyzed using SPSS (Version 26.0). Descriptive statistics were used to determine the frequency, percentage, sensitivity, specificity, and positive and negative predictive values. The level of agreement was determined using Cohen's kappa and a Chi-square test was used to measure the association between risk factors and laboratory test outcomes. A -value <0.05 was considered statistically significant.
was confirmed in 28.6% (N=36) of the 126 cases using BACTEC MGIT 960 culture detection method. Approximately, 13% (N=16) of the samples were collected from previously treated TBLN patients, of which 5/16 (31.3%) were multi-drug resistant, 7/16 were drug-sensitive and 4/16 were culture negative. To rule out other non-tuberculous agents, all samples were grown on blood and Mycosel agar plates, and no growth was detected.
The emergence of drug resistant (DR) TB seems to not just be limited to pulmonary form but also to TBLN. In this study we observed a considerable number of microbiologically confirmed relapses among previously treated cases, possibly indicating the need for confirmation of drug resistance using rapid molecular methods or phenotypical methods during treatment follow up.
肺外结核病（EPTB），尤其是结核性淋巴结炎（TBLN），在埃塞俄比亚仍然是一个巨大的公共卫生问题。据报道，大量完成全程抗结核治疗方案的TBLN患者出现淋巴结肿大和其他类似结核病的临床表现。这可能是由于矛盾反应或微生物复发，可能是由于单药/多药耐药。
调查在临床诊断和开始抗结核治疗（新治疗或既往治疗）的淋巴结患者中，作为观察到的治疗失败原因的单药和多药耐药模式的发生率。
于2022年3月至9月对126例疑似TBLN且既往接受过治疗的患者进行了一项横断面研究。使用SPSS（版本26.0）分析数据。描述性统计用于确定频率、百分比、敏感性、特异性以及阳性和阴性预测值。使用科恩kappa系数确定一致性水平，并使用卡方检验测量危险因素与实验室检查结果之间的关联。P值<0.05被认为具有统计学意义。
使用BACTEC MGIT 960培养检测方法在126例病例中的28.6%（N = 36）中确诊。大约13%（N = 16）的样本来自既往接受过治疗的TBLN患者，其中5/16（31.3%）为多药耐药，7/16为药物敏感，4/16培养阴性。为排除其他非结核病原体，所有样本均在血平板和霉菌琼脂平板上培养，未检测到生长。
耐药结核病的出现似乎不仅限于肺结核形式，也见于TBLN。在本研究中，我们在既往治疗的病例中观察到相当数量的微生物学确诊复发，这可能表明在治疗随访期间需要使用快速分子方法或表型方法确认耐药性。
